Microsoft word - suprep- full packet

SUPREP ® PREP
North Jersey Gastroenterology and Endoscopy Associates
1825 Route 23 South, Wayne, NJ 07470
Telephone 973-633-1484
Patient:_______________________________________________ Doctor: _____________________
Date of procedure:________________ Time to report: _________ Time of procedure:________________
Location: Endoscopy Center, 1st Floor Wayne Surgical Center
Chilton Hospital Access Center

Latex allergy: Y or N

DIET: No iron supplement, seeds, nuts, quinoa, corn, popcorn, tomatoes, cucumbers or salad for three days
before the procedure.
PREPARATION: Please obtain the following items from your pharmacy before the procedure:
ON THE DAY BEFORE THE PROCEDURE:
1. Before 10 am., you may have a light breakfast. This can include cereal, breads, and milk products,
but cannot include fresh fruits, vegetables, salad or meats. 2. After 10 a.m., only clear liquids can be consumed. Clear liquids are as follows:
Clear juices (apple, white grape, not red) 3. At 5 p.m. pour one (1) 6 ounce bottle of SUPREP liquid into the mixing container. Add cool
drinking water to the 16 ounce line on the container next. Drink all the liquid in the container. You
must drink two (2) more 16 ounce containers of water or clear liquid over the next one hour.
. The prep is more easily tolerated if chilled and taken with a straw. Feelings of bloating, nausea or
chills are common after the first few glasses. This is temporary and will decrease once bowel
movements begin. If the nausea worsens, stop drinking the solution for 30 minutes, then resume
drinking every 15 minutes as before.
4. Clear liquids may be continued following the preparation up to 5 hours prior to the procedure. ON THE DAY OF THE PROCEDURE:
**IMPORTANT- Please make sure to follow our instructions as written.
1. Six hours prior to the procedure, repeat the above instructions. Pour one (1) 6 ounce bottle of
SUPREP liquid into the mixing container. Add cool drinking water to the 16 ounce line on the
container next. Drink all the liquid in the container. You must then drink two (2) more 16 ounce
containers of water or clear liquid over the next one hour.
2. You MUST FINISH drinking all liquids (PREP AND WATER) at least 5 hours prior to your
scheduled arrival time or your procedure will be delayed.
****DO NOT CONSUME ANYTHING ELSE BY MOUTH-NOT EVEN WATER****
3. Following the prep, you should expect to have clear yellow fluid passing into the toilet.
4. Wear loose, comfortable clothing. Bring your glasses (if necessary). Do not bring valuables such as
jewelry with you. The endoscopy facility cannot be responsible for your belongings. ADDITIONAL INFORMATION:
1. If you take blood pressure pills, pills for your heart, seizure medications or Parkinson’s medications, take them as usual with a small amount of water. Ask your doctor if you are not sure. 2. If you take daily aspirin, Coumadin, Plavix, Ticlid, vitamin E, aspirin, Advil, Nuprin, Motrin or any other “anti-inflammatory/arthritis pills make sure you have discussed this with your physician. 3. If you take Coumadin, take the last dose: _____________________________________
4. After the procedure, you must not drive, work or do anything that could result in injury.
5. YOU MUST HAVE A RIDE HOME OR THE PROCEDURE WILL BE CANCELLED! Your
ride should be available 1 ½ hours after you are dropped off for your procedure. Rev 6/13

Source: http://www.njgastro.net/docs/Suprep.pdf