Carolina Digestive Health Associates
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- Cuthbert French
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1 Carlina Digestive Health Assciates Prcedure Infrmatin Yu are scheduled fr an ERCP. Please read all f the attached infrmatin as sn as pssible s yu are prepared fr yur upcming prcedure. PHYSICIAN PERFORMING PROCEDURE: DATE: PROCEDURE TIME: LOCATION: CHECK-IN TIME: Please clsely fllw the instructins belw in prepping fr yur prcedure. It is very imprtant that yu fllw them carefully, r we will be unable t perfrm the prcedure and it will be cancelled. This packet includes: 1. Instructins fr 7 days, 5 days and 2 days prir t yur prcedure 2. Instructins fr diabetic patients 3. Instructins fr the day f yur prcedure 4. ERCP infrmatin This infrmatin shuld answer mst f the questins yu may have abut yur prcedure. If yu still need additinal assistance, please cntact ur ffice nearest yu. As a reminder, if yu cancel yur prcedure less than 3 business days befre yur scheduled appintment, yu may be charged a $100 n shw fee. Yu must have an adult driver with yu at all times when yu are at the endscpy center/hspital. Yu shuld expect t be at the endscpy center/hspital between 2 ½ and 3 hurs. Yur driver must stay at the endscpy center/hspital during yur prcedure. Carlina Digestive Health Assciates Phne Numbers Billingsley: Matthews: Belmnt: Mnre: Cncrd: Pineville: Davidsn: University:
2 Medicatin Instructins 7 DAYS BEFORE PROCEDURE: Discntinue taking Phentermine and Hydrxycut. 5 DAYS BEFORE PROCEDURE: Discntinue taking medicines that may thin yur bld, such as: COUMADIN, PLAVIX, TICLID, Heparin, Aspirin, Excedrin, Effient, Alka Seltzer, Empirin, Ectrin, Bufferin, Ascriptin, Ibuprfen, Mtrin, Advil, Medipren, Nuprin, Naprxen (Naprsyn), Aleve, Sulindac, Clinril, Pirxicam, Feldene, Indmethacin, Indcin, Diclfenac and Vltaren unless therwise directed by yur physician. If any f these are a medical necessity fr yu, please infrm us as sn as pssible by calling ur ffice. Please stp all irn prducts, multi-vitamins, and fish il. IF YOUR DOCTOR HAS PRESCRIBED ASPIRIN: Please decrease yur aspirin t 81 mg a day. After yur prcedure, yu will be infrmed when yu may resume taking yur regular medicatins. Tylenl is safe t use prir t this prcedure. *** If yu d nt see yur medicatin r supplement listed here, verify with yur lcal pharmacy yur medicatin desn t include Aspirin. *** *** Cntact us if any majr health prblems ccur between nw and yur prcedure. 2 DAYS BEFORE THE PROCEDURE: Discntinue taking Xarelt, Eliquis, and Pradaxa. If either f these are a medical necessity fr yu, please infrm us NOW. DAY OF THE PROCEDURE If yu take Bld Pressure Medicatins, Heart Medicatins, r Seizure Medicatins take yur medicines, at the times yu nrmally wuld, with a sip f water. GENERAL INSTRUCTIONS FOR DIABETIC PATIENTS Check yur bld glucse during the preparatin perid, especially if yu suspect it is t lw. Yur bld glucse levels may run higher than usual during this perid due t adjustments in yur diabetes medicatin. If bld glucse becmes extremely high (greater than 350), call ur ffice, yur PCP r yur diabetes dctr. Fr lw bld glucse levels, yu may drink sweetened clear liquids (such as apple juice). Infrm the endscpy nurse upn arrival if this was necessary. Resume yur usual diabetic diet and medicatins immediately after yur prcedure(s) unless yu are instructed t d therwise. If yur diet remains restricted fllwing the prcedure, ask fr instructins regarding diabetic medicatin adjustment.
3 Diabetic Instructins If yu are diabetic and having an ERCP, fllw these instructins: ORAL DIABETES MEDICATIONS - If yu take ral diabetic medicatins, please hld these medicatins the mrning f yur ERCP. Restart these medicatins after the prcedure when yu resume eating. INSULIN If yu take insulin f any type, fllw these guidelines: Lantus r Levmir - Take yur usual dse unless yur bld glucse is tightly cntrlled (glucse levels are usually in the nrmal range r are ccasinally lw). In that case, reduce the dsage by ne frth n the day befre yur ERCP. Resume yur usual dse after the prcedure. (Example: If yu take 40 units, adjust t 30 units) 70/30 r 75/25 insulin On the mrning f the prcedure, take half f yur usual dse r, if yu have the prcedure befre 11:00am, bring yur insulin with yu t take befre yur next meal. Resume yur usual dse after the prcedure. Meal-related insulin On the mrning f the prcedure, take half yur usual dse r, if yu have the prcedure befre 11:00am, bring yur insulin with yu t take befre yur next meal. Resume yur usual dse after the prcedure. Sliding Scale Insulin Cntinue this as usual. Insulin pump Reduce the dse f yur insulin by ne frth the day f the prcedure r cnsult yur endcrinlgist fr recmmendatins. Resume yur usual dse after the prcedure. (Example: If yu take 4 units/hur, adjust t 3 units/hur)
4 ERCP Please fllw the set f instructins marked belw based n yur scheduled appintment time: Mrning Appintment Instructins (Between 7am 12:40pm) Yur prcedure is at, please fllw the instructins belw: After Midnight n the evening befre yur prcedure NO Slid fds. Hwever yu may have clear liquids ONLY up until (6 hurs prir t yur scheduled prcedure time). Clear liquid diet guidelines: Yu may have water, clear fruit juices (white grape, apple), sda (Sprite, Ginger Ale, Pepsi, Cke, and diet clas), Jell-O, ice pps, brth, builln, cffee, tea, Gatrade Yu may NOT have anything red, purple, blue, range Yu may NOT have milk r milk prducts (this includes nn-dairy creamers) During the 6 hurs prir t yur scheduled prcedure time, yu may NOT have anything t eat r drink including: water and all ther clear liquids, gum, candy, chewing tbacc, snuff r fd items. Afternn Appintment Instructins (Between 12:40pm 5pm) Yur prcedure is at, please fllw the instructins belw: After Midnight n the evening befre yur prcedure NO Slid fds. Hwever yu may have clear liquids ONLY up until (6 hurs prir t yur scheduled prcedure time). Clear liquid diet guidelines: Yu may have water, clear fruit juices (white grape, apple), sda (Sprite, Ginger Ale, Pepsi, Cke, and diet clas), Jell-O, ice pps, brth, builln, cffee, tea, Gatrade Yu may NOT have anything red, purple, blue, range Yu may NOT have milk r milk prducts (this includes nn-dairy creamers) During the 6 hurs prir t yur scheduled prcedure time, yu may NOT have anything t eat r drink including: water and all ther clear liquids, gum, candy, chewing tbacc, snuff r fd items. After The Prcedure: Fllw the diet instructins given t yu by yur physician after the prcedure. If yu experience abdminal pain, fever r painful swallwing please cntact ur ffice immediately. If it is after hurs please g t the emergency rm t be evaluated.
5 ERCP (End Retrgrade Chlangipancreatgrphay) Infrmatin Endscpic retrgrade chlangipancreatgraphy (ERCP) enables the physician t diagnse and treat prblems in the liver, gallbladder, bile ducts, and pancreas. The liver is a large rgan that, amng ther things, makes a liquid called bile that helps with digestin. The gallbladder is a small, pear-shaped rgan that stres bile until it is needed fr digestin. The bile ducts are tubes that carry bile frm the liver t the gallbladder and small intestine. These ducts are smetimes called the biliary tree. The pancreas is a gland that prduces chemicals that help with digestin. ERCP may be used t discver the reasn fr jaundice, upper abdminal pain, r abnrmal bld tests. ERCP cmbines the use f x-rays and an endscpe, which is a lng, flexible, lighted tube. Thrugh it, the physician can see the inside f the stmach, dudenum, and ducts in the biliary tree and pancreas. Fr the prcedure, yu will lie n yur left side n an examining table in an x-ray rm. Yu will be given medicatin t numb the back f yur thrat and a sedative t help yu relax during the exam. After yu are sedated, the physician will insert the endscpe thrugh yur muth. The physician will then guide the scpe thrugh yur esphagus, stmach, and dudenum until it reaches the spt where the ducts f the biliary tree and pancreas pen int the dudenum. At this time, yu will be turned t lie flat n yur stmach, and the physician will pass a small plastic tube thrugh the scpe. Thrugh the tube, the physician will inject a dye int the ducts t make them shw up clearly n x-rays. If the exam shws a gallstne r narrwing f the ducts, the physician can insert instruments int the scpe t remve r wrk arund the bstructin. Tissue samples (bipsy) can be taken fr further testing. Als, the pening may be enlarged. ERCP takes 30 minutes t 2 hurs. After the prcedure, yu will need t stay at the hspital fr a few hurs until the sedative wears ff. If yu have abdminal pain, nausea, r vmiting after the prcedure, yur discharge frm the hspital may be delayed. If any kind f treatment is dne during the ERCP, such as remving a gallstne, yu may need t stay in the hspital vernight.
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