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Colonoscopy
Colonoscopy allows inspection of the mucosa of the entire colon, ileocecal valve, and terminal ileum using a
flexible fiberoptic colonoscope inserted through the anus and advanced to the terminal ileum. The colonoscope
is a multichannel instrument that allows viewing of the gastrointestinal (GI) tract lining, insufflation of air,
aspiration of fluid, obtaining of tissue biopsy samples, and passage of a laser beam for obliteration of tissue and
control of bleeding. Mucosal surfaces of the lower GI tract are examined for ulcerations, polyps, chronic
diarrhea, hemorrhagic sites, neoplasms, and strictures. During the procedure, tissue samples may be obtained
for cytology, and some therapeutic procedures may be performed, such as excision of small tumors or polyps,
coagulation of bleeding sites, and removal of foreign bodies.

INDICATIONS:
• Assess GI function in a patient with a personal or family history of colon cancer, polyps, or ulcerative colitis
• Confirm diagnosis of colon cancer and inflammatory bowel disease
• Detect Hirschsprung’s disease and determine the areas affected by the disease
• Determine cause of lower GI disorders, especially when barium enema and proctosigmoidoscopy are
inconclusive
• Determine source of rectal bleeding and perform hemostasis by coagulation
• Evaluate postsurgical status of colon resection
• Evaluate stools that show a positive occult blood test, lower GI bleeding, or change in bowel habits
• Follow up on previously diagnosed and treated colon cancer
• Investigate iron-deficiency anemia of unknown origin
• Reduce volvulus and intussusceptions in children
• Remove colon polyps
• Remove foreign bodies and sclerosing strictures by laser

RESULT:
Normal findings in:
• Normal intestinal mucosa with no abnormalities of structure, function, or mucosal surface in the colon or
terminal ileum

Abnormal findings in:

• Benign lesions • Foreign bodies
• Bleeding sites • Hemorrhoids
• Bowel distention • Polyps
• Bowel infection or inflammation • Proctitis
• Colitis • Tumors
• Colon cancer • Vascular abnormalities
• Crohn’s disease
• Diverticula

NTERFERING FACTORS:
This procedure is contraindicated for:
• Patients with bleeding disorders or cardiac conditions
• Patients with bowel perforation, acute peritonitis, acute colitis, ischemic bowel necrosis, toxic colitis, recent
bowel surgery, advanced pregnancy, severe cardiac or pulmonary disease, recent myocardial infarction,
known or suspected pulmonary embolus, and large abdominal aortic or iliac aneurysm
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• Patients who have had a colon anastomosis within the past 14 to 21 days, because an anastomosis may
break down with gas insufflations

Factors that may impair clear imaging:

• Gas or feces in the GI tract resulting from inadequate cleansing or failure to restrict food intake before the
study
• Retained barium from a previous radiological procedure
• Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization
and cause unclear images
• Patients who are very obese, or who may exceed the weight limit for the equipment
• Inability of the patient to cooperate or remain still during the procedure because of age, significant pain, or
mental status
• Severe lower GI bleeding or the presence of feces, barium, blood, or blood clots, which can interfere with
visualization
• Spasm of the colon, which can mimic the radiographic signs of cancer (Note: the use of IV glucagon
minimizes spasm)
• Inability of the patient to tolerate introduction of or retention of barium, air, or both in the bowel

Other considerations:
• Complications of the procedure may include hemorrhage and cardiac arrhythmias.
• The procedure may be terminated if chest pain or severe cardiac arrhythmias occur.
• Failure to follow dietary restrictions and other pretesting preparations may cause the procedure to be
canceled or repeated.
• Bowel preparations that include laxatives or enemas should be avoided in pregnant patients or patients with
inflammatory bowel disease, unless specifically directed by a health care provider (HCP).
• Consultation with a HCP should occur before the procedure for radiation safety concerns regarding younger
patients or patients who are lactating.
• Risks associated with radiation overexposure can result from frequent x-ray procedures. Personnel in the
examination room with the patient should wear a protective lead apron or leave the area while the
examination is being done. Personnel working in the examination area should wear badges to record their
level of radiation exposure.

NURSING IMPLICATIONS AND PROCEDURE

PRETEST:
➧ Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
➧ Inform the patient that the procedure assesses the colon.
➧ Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to
latex, iodine, seafood, anesthetics, or contrast medium.
➧ Obtain a history of patient’s GI system, symptoms, and results of previously performed laboratory tests and diagnostic
and surgical procedures.
➧ Note any recent procedures that can interfere with test results, including examinations using bariumor iodine-based
contrast medium. Ensure that barium studies were performed more than 4 days before the CT scan.
➧ Ensure that this procedure is performed before an upper GI study or barium swallow.
➧ Record the date of the last menstrual period and determine the possibility of pregnancy in perimenopausal women
➧ Obtain a list of the patient’s current medications including anticoagulants, aspirin and other salicylates, herbs,
nutritional supplements, and nutraceuticals (see Appendix F). Such products should be discontinued by medical
direction for the appropriate number of days prior to a surgical procedure. Note the last time and dose of medication
taken.
➧ Note intake of oral iron preparations within 1 wk before the procedure because these cause black, sticky feces that are
difficult to remove with bowel preparation.
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➧ Review the procedure with the patient. Address concerns about pain and explain that some pain may be experienced
during the test, and there may be moments of discomfort. Inform the patient that the procedure is performed in a GI lab,
by a HCP, with support staff, and takes approximately
30 to 60 min.
➧ Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support
before, during, and after the procedure.
➧ Inform the patient that it is important that the bowel be cleaned thoroughly so that the physician can visualize the
colon. Inform the patient that a laxative and cleansing enema may be needed the day before the procedure, with
cleansing enemas on the morning of the procedure, depending on the institution’s policy.
➧ Instruct the patient to remove all external metallic objects from the area to be examined.
➧ Instruct the patient to eat a low-residue diet for several days before the procedure and to consume only clear liquids
the evening before the test. The patient should fast and restrict fluids for 8 hr prior to the procedure. Protocols may vary
from facility to facility.
➧ Make sure a written and informed consent has been signed prior to the procedure and before administering any
medications.
➧ Ensure that ordered laxatives were administered late in the afternoon of the day before the procedure.
➧ Assess for completion of bowelpreparation according to the institution’s procedure.
➧ Instruct the patient to remove all external metallic objects from the area to be examined.
➧ Have emergency equipment readily available.
➧ Instruct the patient to void prior to the procedure and to change into the gown, robe, and foot coverings provided.
➧ Instruct the patient to cooperate fully and to follow directions. Instruct the patient to remain still throughout the
procedure because movement produces unreliable results.
➧ Observe standard precautions, and follow the general guidelines in Appendix A. Positively identify the patient, and
label the appropriate containers with the corresponding patient demographics, date, and time of collection.
➧ Obtain and record baseline vital signs.
➧ An IV line may be started to allow infusion of a sedative or IV fluids.
➧ Administer medications, as ordered, to reduce discomfort and to promote relaxation and sedation.
➧ Place the patient on an examination table in the left lateral decubitus position and drape with the buttocks exposed.
➧ The HCP performs a visual inspection of the perianal area and a digital rectal examination.
➧ Instruct the patient to bear down as if having a bowel movement as the fiberoptic tube is inserted through the rectum.
➧ The scope is advanced through the sigmoid. The patient’s position is changed to supine to facilitate passage into the
transverse colon. Air is insufflated through the tube during passage to aid in visualization.
➧ Instruct the patient to take deep breaths to aid in movement of the scope downward through the ascending colon to the
cecum and into the terminal portion of the ileum.➧
➧ Air is insufflated to distend the GI tract, as needed. Biopsies, cultures, or any endoscopic surgery is performed.
➧ Foreign bodies or polyps are removed and placed in appropriate specimen containers, labeled, and sent to the
laboratory.
➧ Photographs are obtained for future reference.
➧ At the end of the procedure, excess air and secretions are aspirated through the scope, and the colonoscope is
removed.

POST-TEST:
➧ A report of the examination will be sent to the requesting HCP, who will discuss the results with the patient.
➧ Monitor the patient for signs of respiratory depression.
➧ Monitor vital signs and neurological status every 15 min for 1 hr, then every 2 hr for 4 hr, or as ordered. Take
temperature every 4 hr for 24 hr. Compare with baseline values. Notify the HCP if temperature is elevated. Protocols
may vary from facility to facility.
➧ Observe the patient until the effects of the sedation have worn off.
➧ Instruct the patient to resume usual diet, fluids, medications, and activity, as directed by the HCP.
➧ Monitor for any rectal bleeding. Instruct the patient to expect slight rectal bleeding for 2 days after removal of polyps or
biopsy specimens, but that an increasing amount of bleeding or sustained bleeding should be reported to the HCP
immediately.
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➧ Observe the patient for indications of chest pain, abdominal pain ortenderness, or breathing problems. If these
symptoms are present or increase in frequency or severity, the change should be reported to a HCP immediately.
➧ Inform the patient that belching, bloating, or flatulence is the result ofair insufflation.
➧ Emphasize that any severe pain, fever, difficulty breathing, or GI bleeding must be reported to the HCP immediately.
➧ Encourage the patient to drink several glasses of water to help replace fluids lost during the preparation for the test.
➧ Carefully monitor the patient for fatigue and fluid and electrolyte imbalance.
➧ A report of the examination will be sent to the requesting HCP, who will discuss the results with the patient.
➧ Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle.
Provide teaching and information regarding the clinical implications of the test results, as appropriate.
➧ Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP.
Answer any questions or address any concerns voiced by the patient or family.
➧ Depending on the results of this procedure, additional testing may be needed to evaluate or monitor progression of the
disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s
symptoms and other tests performed.

RELATED MONOGRAPHS:
➧ Related tests include barium enema, biopsy intestinal, capsule endoscopy, carcinoembrionic and cancer antigens, CT
abdomen, CT colonoscopy, fecal analysis, KUB, MRI abdomen, and proctosigmoidoscopy.
➧ Refer to the Gastrointestinal System table in the back of the book for related tests by body system.