0:01

What about, uh, current, uh, technique

0:04

for bowel cleansing?

0:06

Um, many sites have moved from the large volume polyethylene

0:11

glycol, um, prep, which is a wet prep to the dry prep.

0:15

And whereas initially, uh, sites were using sodium phosphate

0:20

or phospho soda, I think

0:22

that many sites have moved towards magnesium citrate

0:25

and mag citrate, um, is smaller volume.

0:28

So you have the patient typically ingest 10 ounces.

0:32

Um, this can be given as a single dose or, um, given twice.

0:36

Um, magnesium citrate is hyperosmolar,

0:39

so it draws fluid into the bowel lumen, uh,

0:42

which induces evacuation.

0:44

It tends to be better about, uh, tolerated by patients, uh,

0:48

and also leaves less residual fluid, um,

0:51

which makes it easier, uh, for interpretation

0:53

and allows actually for typically better, uh, tagging.

0:58

So, uh, 10 ounces of magnesium citrate given

1:01

as either a single dose, uh, or in two doses.

1:05

Uh, or some sites still use, uh, phospho soda.

1:08

And this should be a single dose of 45 ml.

1:11

Remember that phospho soda specifically is contraindicated

1:14

in patients with renal insufficiency

1:17

or patients with, uh, cardiac failure.

1:21

As I mentioned before, the wet prep is the

1:23

polyethylene glycol.

1:25

Uh, this is typically given as a larger volume for liters.

1:29

It is an iso osmolar lavage solution.

1:33

Um, because it is such a large volume, uh, compliance, um,

1:37

may be an issue for patients,

1:39

and it tends to leave much more residual fluid

1:42

in the colon lumen, uh, which can, uh, be problematic

1:46

for interpretation and lead to less, uh,

1:49

homogeneous uh, tagging.

1:52

There is an option for two liters of polyethylene glycol.

1:55

For some reason, this tends to be a more expensive option.

1:58

Um, and there, uh, are studies showing

2:00

that the four liter volume is no better

2:02

than the two liter volume.

2:05

This is the Akron Tagging Pro protocol.

2:09

Uh, patients typically have to

2:11

bone clearly would die the day before the CTC.

2:15

Um, the, um, tagging is achieved with, uh,

2:19

both a high density variant product, uh, that is, uh,

2:23

given in three quats at 8:00 AM 11:00 AM

2:26

and at 2:00 PM um, with the largest, uh,

2:29

volume at the 8:00 AM 20 ml nin ml,

2:33

the 11 2:00 PM Now, there's a certain order that this needs

2:37

to be given, and so this, uh,

2:40

higher density varying product, ol b uh, is meant

2:44

to tag any solid stool

2:46

that's in the, the late afternoon.

2:50

The patient receives the laxative,

2:52

and this can either be magnesium citrate, um,

2:56

or your polyethylene. Um, and

2:58

Then this evacuates all of the solid stool,

3:01

or it's meant to evacuate as much

3:03

of the solid stool as possible.

3:05

7:00 PM bial, uh, are given as an adjunct,

3:10

uh, for additional cleansing.

3:12

And then in the evening, um,

3:15

water soluble contrast is given gastro, uh, at nine,

3:20

starting at 9:00 PM uh, again in three aliquots

3:23

of 20 ml each.

3:25

Uh, and, uh, the I ated contrast is meant

3:29

to tag any residual fluid,

3:31

so the high density barrier product in the morning

3:35

and early afternoon to tag solid stool,

3:38

and then the laxative in the late afternoon to evacuate most

3:42

of the solid stool.

3:43

Um, and then the IOD contrast in the evening.

3:47

Uh, to tag any residual fluid, this has worked quite loudly.

3:51

This is a, uh,

3:53

alternative tagging protocol from the University

3:55

of Wisconsin, um, where they use, uh, two doses

3:59

of magnesium citrate.

4:01

Some sites have found that the one bottle

4:03

of magnesium citrate doesn't cleanse, uh, patients,

4:06

some patients well enough.

4:08

Um, and this is, uh, using two, two, uh, bottles.

4:12

So, uh, again, um, a, uh,

4:15

clear liquid diet on the day before.

4:17

Um, physical tablets are given at 11:00 AM The first bottle

4:21

of magnesium citrate is given in the late afternoon.

4:24

Um, and then in the early evening, uh, the second bottle

4:27

of magnesium citrate is given,

4:29

and then a larger volume of, uh,

4:32

lower density varied products can be given after that.

4:36

Um, and then the ID contrast is given, similar

4:40

to the AK protocol starting at 9:00 PM I think

4:45

that irrespective of whichever, um, uh, protocol you use,

4:50

it's important to have a clear prep sheet, uh, to hand out

4:53

to patients or to send to them.

4:56

Um, graphics are, are appreciated by patients we have found,

5:00

and, uh, you're very welcome to, uh,

5:03

use the one that I have shown here.

5:05

Um, but it really goes through step by step, uh,

5:08

what the patient needs to, uh, ingest

5:10

and how they, um, uh, mix things up.

5:13

So I think that, uh, this, uh, has been very helpful for.