How to take Plenvu Bowel Prep

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ENDOSCOPY – PLENVU™ BOWEL PREP

This booklet has been produced to help you prepare better for your procedure.

It is important that you read this information carefully, that way you will get the best possible preparation for your colon examination.

If the bowel is not sufficiently cleared of stool the risks are:

We might not even be able to perform your procedure when you arrive if you have not completed the prep.
The views of the lining of the bowel may be poor and the risk is we could miss something.
You may need to have a repeat procedure within a short time period which means taking the prep again and having a delay to a diagnosis.
The two pictures below demonstrate the difference between good and bad bowel cleansing.

The Plenvu™ preparation we have sent to you is not a particularly nice flavour, however it has been proven to be one of the safest and most effective ways of cleaning your bowel.

The first dose is slightly easier to tolerate than the second dose. This is because the second dose has the addition of ascorbate which tastes very salty and bitter; however, it is extremely important to take both doses to achieve success.

To get the best out of the preparation it is important that you follow ALL the instructions laid out:

Take a low fibre diet for 3 days prior to your procedure.
- Drink the Plenvu™ slowly over 1 hour (see charts further down)
- Take a MINIMUM extra 500mls of clear fluids after each dose.
- Read the Hints and Tips and use them to your advantage.

GOOD PREP BEGINS A WEEK BEFORE YOUR PROCEDURE 7 DAYS BEFORE YOUR PROCEDURE:

Stop taking any of the following medication:

Imodium® (loperamide)
Codeine phosphate • Lomotil (co-phenotrope)

(If you are taking codeine-based medication you may need to discuss with your doctor an alternative to allow the bowel preparation to be the best it can be. Codeine causes constipation and it is harder for the prep to do its job)

Iron tablets
Fybogel® (ispaghula husk)

Anticoagulants: (full instructions will be on the pre-procedure patient leaflet and consent form)

If you are taking any of the following and you are unclear of the instructions, please contact the endoscopy department for advice.

Warfarin	Clopidogrel
Prasugrel	Ticagrelor
Dabigatran	Rivaroxaban
Apixaban	Phenindione
Edoxaban

If you are diabetic, please follow the instructions on the pre-procedure patient leaflet that will arrive with your consent form.

Please note all other medications such as heart tablets and blood pressure tablets and folic acid should be continued as normal, including on the day of your test.

STOP EATING NUTS AND SEEDS IN YOUR DIET, THIS INCLUDES SEEDED BREAD

Familiarise yourself with the Low Fibre diet sheet, which is found at the back of this booklet, please ensure you have enough food in for the period you are asked to follow this diet.

3 DAYS BEFORE YOUR PROCEDURE:

You will need to start eating only foods highlighted in green which are on the low fibre diet sheet at the end of this booklet, please familiarise yourself now so that you completely understand what is expected.

ON THE DAY BEFORE YOUR APPOINTMENT:

REMEMBER ONCE YOU START THE BOWEL PREP NO MORE FOOD

If your appointment is before 11am please follow the morning appointment instructions very carefully.

If your appointment is after 11am please follow the afternoon appointment Instructions very carefully.

INSTRUCTIONS FOR MORNING APPOINTMENT (BEFORE 11AM): (THE DAY BEFORE THE APPOINTMENT)

Have a light breakfast, take food from the green column by 09:00hrs, after this do not eat any more solid food, until after your procedure.

Please drink plenty of clear fluids such as tea without milk; coffee without milk; plain water; water with squash/cordial (not blackcurrant); ANY fizzy drinks including Lucozade; Bovril; Consommé; or any thin watery soup with ALL the solid bits sieved out. In moderation you can also have jellies, any flavour except red or blackcurrant, this is because the darker ones can stain the bowel.

Please remember that even after you have had your final light breakfast at 09:00, you can continue to:

suck clear boiled sweets and / or clear mints

and

You may add sugar or glucose to your drinks

THE DAY BEFORE YOUR PROCEDURE:

14:30

Mix the first dose of Plenvu (one sachet marked dose 1) in a jug with 500mls of water.

Divide into 4 smaller glasses and store in the fridge.

Make solution and put in the fridge, it is better tolerated when cold!

15:00

Drink one glassful of Plenvu™ every 15 minutes (sip it slowly, if it makes you feel sick, slow down further) Tick off each glass as you go

After or alongside

In addition, drink a glassful of clear fluid (such as water; squash; UHT clear apple juice or Bovril) Tick off each glass as you go. This can be drunk by alternating between Plenvu™ and clear fluid of choice.

By 19:30 Mix second dose of Plenvu™ ready and keep in the fridge

The 2nd dose should be mixed in the same way as in the 1st dose, this time sachet A and sachet B should be mixed together.

20:00

Drink one glassful of Plenvu™ every 15 minutes (sip it slowly, if it makes you feel sick, slow down further) Tick off each glass as you go

After or alongside

INSTRUCTIONS FOR AFTERNOON APPOINTMENTS (AFTER 11AM) (DAY BEFORE THE APPOINTMENT)

Have a light breakfast and lunch taking food from the green column by 3pm, after this do not eat any more solid food, until after your procedure.

Please drink plenty of clear fluids such as tea without milk; coffee without milk; plain water; water with squash/cordial (not blackcurrant); ANY fizzy drinks including Lucozade; Bovril; Consommé; or any thin watery soup with ALL the solid bits sieved out. In Moderation you can have jelly any flavour except red or blackcurrant, this is because the darker flavours can stain the bowel.

Please remember that even after you have had your final light meal at 3pm, you can continue to:

To suck clear boiled sweets and / or clear mints

and

You may add sugar or glucose to your drinks

THE DAY BEFORE YOUR PROCEDURE:

16:30

Mix the first dose of Plenvu™ (one sachet marked dose 1) in a jug with 500mls of water.

Divide into 4 smaller glasses and store in the fridge.

Make solution and put in the fridge, it is better tolerated when cold!

17:00

Drink one glassful of Plenvu™ every 15 minutes (sip it slowly, if it makes you feel sick, slow down further) Tick off each glass as you go

After or alongside

Before you go to bed, mix up the next dose of Plenvu™ and keep it in the fridge ready for the following morning. This is done in the same way as 1st dose, this time sachet A and sachet B should be mixed together.

THE DAY OF YOUR PROCEDURE:

05:00

Drink one glassful of Plenvu™ every 15 minutes (sip it slowly, if it makes you feel sick, slow down further) Tick off each glass as you go

05:30-06:30

Remember, to alternate the Plenvu™ with clear fluid of choice.

There is no right or wrong way to get the doses down, but it is important to drink slowly, drink cold and drink PLENTY of clear fluids.

REMEMBER IT IS VITALLY IMPORTANT TO TAKE ALL THE BOWEL CLEANSING AGENT. STICK TO THESE TIMINGS BUT SLOW DOWN TO ENSURE THAT THE 2 DOSES ARE TOLERATED. DOSE 2 WILL BE LESS TOLERABLE THAN THE FIRST DOSE THIS IS DUE TO THE ADDITION OF SACHET B WHICH HAS SLIGHTLY DIFFERENT INGREDIENTS IN.

Thank you for your co-operation and if any problems contact Endoscopy for advice.

GENERAL INFORMATION/TIPS:

LOW FIBRE DIET:

PLEASE START 3 DAYS PRIOR TO YOUR PROCEDURE:

Food Type	Food ALLOWED	Food to AVOID
Bread, cereals and Flour based products	White bread, English muffins, plain scones/ croissants/ bagels without dried fruits, crumpets, pancakes, white pitta and naan bread, white chapatti and tortillas, poppadum’s, Yorkshire pudding, dumplings Refined breakfast cereal, such as Special K, Cornflakes and Rice Krispies with no dried fruit/nuts White rice, pasta, noodles, tapioca, semolina Corn/ white flour Plain biscuits such as rich tea/ custard creams Plain crackers Plain sponge cake	Wholemeal, granary, or rye bread, chapatti and pitta bread, fibre enriched bread, All fruit / nut breads, including walnut, granary or fruit muffins or scones and pastries with fruit/ dried fruit. Wholegrain cereals, such as Weetabix, All Bran, porridge oats, muesli, bran, wheat germ and bulgar wheat. Wholegrain and wild rice, pasta, couscous, pearl barley, quinoa, oatmeal, wholegrain noodles Brown, whole meal or granary flour, wheat germ Wholegrain or fruit/ nut biscuits (fig rolls, Garibaldi) Oat biscuits, whole wheat biscuits e.g., flapjacks, whole wheat digestives, fruit cake, rye crispbreads
Meat, legumes, and nuts	Any tender and soft meat, chicken, and fish. Smooth paté (crab, tuna, mackerel, chicken liver) Tofu Eggs Smooth paté (crab, tuna, mackerel, chicken liver)	All beans, lentils, and chickpeas All nuts including coconut All seeds, including pumpkin, chia, sunflower and sesame seeds Plant based protein powders (pea protein, flaxseed protein)
Dairy products, fats, and oils	All types of milk and milk alternatives, cream, sour cream, crème fraiche, cottage cheese Smooth yoghurt and fromage frais (no nuts or fruit) Most cheeses	Any milk and products containing fruit, nuts, seeds, or cereals

Meat, legumes, and nuts	Any tender and soft meat, chicken, and fish. Smooth paté (crab, tuna, mackerel, chicken liver) Tofu Eggs Smooth paté (crab, tuna, mackerel, chicken liver)	All beans, lentils, and chickpeas All nuts including coconut All seeds, including pumpkin, chia, sunflower and sesame seeds Plant based protein powders (pea protein, flaxseed protein)
Dairy products, fats, and oils	All types of milk and milk alternatives, cream, sour cream, crème fraiche, cottage cheese Smooth yoghurt and fromage frais (no nuts or fruit) Most cheeses	Any milk and products containing fruit, nuts, seeds, or cereals
Vegetables	Allowed foods (flesh only – no peel / skin, seeds, or stalks), cooked Boiled/ mashed potato, sweet potato, pumpkin/butternut squash, zucchini (courgette) cauliflower and broccoli tips, asparagus tips, aubergine, marrow, carrot, swede, beetroot Sieved tomato sauces/ tinned tomatoes, including passata and tomato puree Strained vegetable juices Allowed foods (salad) Skinless and seedless cucumber and tomato Shredded lettuce, young spinach, rocket (chew thoroughly)	Avoid these foods (all raw vegetables) Avoid all other vegetables not listed in ‘Allowed’ list Including artichoke, cabbage, curly kale, celery, fennel, leeks, okra, peppers, peas, mature spinach, sprouts, sweetcorn, yam, cassava, Salad/ roast/ croquette potato and chips

Fruits	Allowed foods: flesh only (no peel/ skin, seeds) Pawpaw, melons, banana (ripe), seedless grapes Peeled/ canned/ stewed or well-cooked peaches, nectarine, apple, pear, plums, fruit cocktail, mango, lychees, apricot Canned fruits except pineapple/ prunes Fruit juice – no pulp Avocado (smooth, guacamole)	Avoid these foods: fruit with skin, pips or of a very “fibrous” texture Apples, pears, pineapple, citrus fruit, berries, and currants Dried fruit Canned pineapple, prunes All other fruit not ‘Allowed’ Smoothies
Drinks	Strained fruit and vegetable juices, milk and milk alternatives, water, soft drinks, tea and coffee, herbal teas	Fruit and vegetable juices with pulp, prune juice Fruit and vegetable smoothies
Miscellaneous	Smooth or sieved soup All fats including butter, oil, margarine Sugar, honey, golden syrup, custard powder, boiled sweets, mints, toffee, caramel, marshmallows, plain/milk/white chocolate Seedless jam and marmalade Sorbet, ice cream, jelly, smooth puddings (custard, rice pudding, semolina, tapioca, mousse) Pepper, salt, herbs, and spices in moderation (dried or finely chopped) Bovril, Oxo, Miso soup with no seaweed, marmite Smooth sauces (gravy, ketchup, soy sauce, tamari) Plain crisps, plain pretzels (without sesame seeds) Smooth nut butter

Meal Ideas:

Breakfasts:

Low fibre cereal (from allowed list) with milk and banana.
White toast or bagel with spread and cottage cheese/marmite or jam (seedless)
Scrambled/boiled or poached egg and white toast with spread.

Lunch Ideas:

White roll/bread with spread and cheese/ham/cottage cheese/egg or fish.
Creamy soup and white bread/toast with spread.
Baked potato (NO SKIN) with spread and cheese/tuna and mayo (NO sweetcorn)

Dinner Ideas:

Potato (NO SKIN) white rice/pasta with fish/meat/egg/cheese/creamy sauces or stews.
Small portion of vegetables (see allowed list)
Cheese omelette
Pudding: Sponge and custard, jelly, or smooth yoghurt.

Snack Ideas:

Plain biscuits, smooth yoghurt, crumpet with jam or marmite, fruit (see allowed list)

Contact Details:

If you have any specific concerns about your procedure, that you feel have not been answered and need explaining, please contact the following:

Alexandra Hospital Redditch

Booking Office – 01527 505751
Endoscopy Nursing Staff – 01527 512014

Evesham Community Hospital

01386 502443

Kidderminster Hospital

Booking Office – 01562 826328
Endoscopy Nursing Staff – 01562 513249

Worcestershire Royal Hospital

Booking Office – 01905 760856
Endoscopy Nursing Staff – 01905 733085

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience

We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you.

Feedback

Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)

If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:

Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:

The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day. If you are unable to understand this leaflet, please communicate with a member of staff.

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