Prep forms

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Download Prep Form (PDF, 29KB)

"The Easy Prep" with PEG 3350

NOTE: You must have a driver present when you arrive for your procedure.
Your driver must remain in the waiting room during your procedure.
Public transportation or cabs are not allowed.

Your Medication

If you take Coumadin or Plavix, please notify our staff as soon as possible. We will contact your doctor for orders regarding this medication. All other medication may be taken.

Diabetic patients patients should take ½ the usual dose of insulin/diabetes medication while on this diet. No insulin or other diabetes medication should be taken the morning of the procedure. Please check your blood sugar the morning of the procedure.

Prep: PEG 3350 ELECTROLYTE SOLUTION. This must be purchased at your local pharmacy. (Rx provided)

1. Eat a light breakfast and lunch (by noon) the day before the procedure. This could include eggs, white bread, pasta, and rice. Please do not eat whole fruits or vegetables. (See low residue diet options list) After lunch you must start your clear liquid diet. Clear juices, lemonade, carbonated beverages, Gatorade, sorbet, popsicles, clear broth, hard candy, honey and tea are all acceptable. Do not drink anything containing artificial red dye.
   *You may continue to drink clear liquids until 4 hours before your scheduled procedure time.
2. Mix the gallon of PEG solution with water and chill in the refrigerator for several hours.
3. At 6:00 p.m. the day before the procedure, begin drinking the PEG prep. Drink ½ of the gallon of the solution. It may take 1 to 2 hours to finish the first half of the prep solution. Many patients find the solution is better tolerated if you drink ginger ale or 7-Up in between glasses of PEG solution.
   
   OR
   
   Drink the remaining ½ gallon of the PEG solution at ___________ a.m./p.m. on _____________.

*IF YOUR PROCEDURE HAS BEEN SCHEDULED AT LAKE PARK SURGICARE or at a HOSPITAL, NOTHING BY MOUTH AFTER MIDNIGHT ON THE DAY OF THE PROCEDURE. NO BREATH MINTS/LOZENGES/GUM/ OR BREATH STRIPS.

IMPORTANT: After the procedure, drink 8 ounces of liquid at least 6 times before retiring for the night.