By Barbara Oryszczycz, RN
Nurse Manager, Berks Center for Digestive Health (BCDH)
Reading your instructions prior to the day of your procedure is very important. There are many things involved in scheduling an endoscopic procedure. Reading your instructions at least a week prior to the day of service allows YOU, the patient, to call us if you need clarification or have particular questions or concerns that need to be addressed ahead of time. Important topics we want to highlight and point out to your attention include:
Every patient receives anesthesia for their procedure, unless the patient specifically requests no sedation. Therefore, we have very stringent, non-negotiable rules regarding your oral food and drink intake (NPO or nothing by mouth status). If you are scheduled for either an upper endoscopy or a colonoscopy, you absolutely may not have anything to eat or drink the day of your procedure, except clear, ie see-through/transparent liquids, and you can have these liquids earlier than 4 hours prior to your report time. When you are at the 4 hour mark, prior to your report time, you may then have nothing more to drink and must keep your stomach absolutely empty. Our written instructions given to every patient clarify what are considered ‘clear liquids’. While sedated, patients are unable to protect their airway or clear fluid on their own, so a full stomach or retained fluid in the stomach may cause the fluid to go into your lungs, leading to serious complications such as respiratory compromise and aspiration pneumonia, which could warrant hospitalization and the need for mechanical ventilation on a respirator.
Pay attention to instructions on medications prior to the day of starting your colon preparation. There are certain medications that need to be held for a period of time. Important medications are iron supplements and blood thinners. Iron supplements may appear as old blood in the GI tract. Anticoagulants and anti-platelet medications, collectively called blood thinners, can increase the risk of procedural bleeding, especially if therapies are performed during your endoscopic procedure, such as when tissue is removed (biopsies or polyp removal) . Insulin or any oral diabetic meds have their own special instructions. Providers who monitor your blood sugars should help regulate medication prior to your procedure. No insulin or diabetic meds should be taken the day of your procedure to prevent low blood sugars. Another element that may alter findings are certain food dyes. Red or purple food dye should be avoided as they can cause the fluid inside your digestive tract to look bloody.
Your colon prep is carefully chosen based on your age, health and symptoms; past medical history; and affordability and insurance coverage. A specific instruction sheet accompanies your particular preparation and the details should be read carefully, as your directions are individualized for you and also based on the date and time of your scheduled procedure. Taking the prep properly allows the doctor to thoroughly perform the exam. If there is improper colon cleansing, the visual field is compromised, therefore possibly missing an accurate diagnosis. Maximizing your intake of plent of clear liquids on your prep day will ensure cleansing of your colon. Clear liquids help hydrate and liquefy your stools and accelerate your response to the prep. NO SOLID FOODS SHOULD BE CONSUMED THE ENTIRE DAY PRIOR TO YOUR COLONOSCOPY. Not following these specific steps regarding colon preparation may result in excess retained stool that impedes the ability to complete the exam. The doctor would then be forced to cancel the procedure and then you would subsequently have to repeat the entire prepping process on another day. The drawbacks again would include another prep day, lost time at work, social constraints surrounding finding another driver to bring you for your procedure, re-submitting a request to schedule this procedure to your insurance company, and then scheduling issues that may arise.
Responsible party/ Driver
Having a driver over the age of 18 is crucial before we proceed with your test. Remember you will be receiving sedation and will be considered to be “under the influence”. The patient cannot drive for the remainder of the day or operate any dangerous equipment. If you arrive for the procedure without a driver, the options will be to reschedule, have the procedure un-sedated, or you trying to find a driver last minute. There is a service available at our center, with a patient incurred cost. Public transportation is only allowed if you are accompanied by a responsible adult who will sign your discharge paperwork.
A language barrier should not deter your need to examine and study all of your instructional paperwork, If you cannot read the provided paperwork, please find someone who can review the written details with you at home. If you were seen in the office, we have Spanish-speaking staff members who can help, and interpreter services are available upon request. Family members are encouraged to accompany you on the day of the procedure to assist with interpreting.
Day of procedure
Arriving on time for your procedure is critical. Remember the physician has a schedule that does not have much room for flexibility and is imperative that our schedule runs on time. Physicians will return to the office to see other patients, if there is a no-show or cancellation. Therefore, if unable to keep an appointment or if you are running late, it is a courtesy we ask of you to please notify our Center, so our physicians’ schedules can be accordingly adjusted and other patients may be accomodated. Being late also impacts other patients. We here at BCDH pride ourselves on delivering high quality and timely patient care and our ability to uphold this goal is dependent on YOU.
On the day of procedure you will need to bring:
Having these items with you will help expedite your admission process.
BCDH strives to allow adequate time for each individual patient, and the safety of each patient is our first and foremost goal. Arriving on time allows for you to be ready well in advance for your procedure and facilitates the transfer of information between your nurse, anesthesia team, and your assigned physician, giving everyone the time to review all of your information and allow any last minute questions you might have prior to having your procedure.
Please remember: Be well-prepared, listen to and read your directions carefully, and reach out to us in advance with your questions, so that you can come to your procedure stress-free and have a positive experience with us. Following your instructions makes your procedure experience much easier for your doctor, our staff, and most importantly YOU!!!