Standard Colonoscopy Protocol and Best Practices

Pre-Procedure Assessment

Patient Evaluation

• Review medical history and medications
• Assess anticoagulation status and management needs
• Evaluate cardiac/pulmonary risk factors
• Confirm adequate bowel preparation instructions provided

Equipment Verification

• Colonoscope functionality check
• Light source and processor verification
• CO2 insufflator setup
• Emergency equipment accessibility

Procedure Setup

Patient Positioning

1. Left lateral position initially
2. Knees flexed toward chest
3. Arms comfortable and secured

Monitoring Setup

• Pulse oximetry
• Blood pressure monitoring
• ECG if indicated
• Capnography for deep sedation

Sedation Protocol

Standard Sedation

• Midazolam 1-2mg IV initial dose
• Fentanyl 25-50mcg IV initial dose
• Titrate as needed for comfort

Documentation Requirements

• Vital signs q5min
• Medication doses and timing
• Level of consciousness

Procedure Technique

Insertion Phase

1. Digital rectal examination
2. Gentle scope insertion with minimal air insufflation
3. Use of position changes as needed
4. Careful navigation through flexures

Withdrawal Phase

• Minimum 6-minute withdrawal time
• Careful mucosal inspection
• Photo documentation of cecum and terminal ileum
• Retroflexion in rectum

Post-Procedure

Recovery Monitoring

• Vital signs q15min until stable
• Assess pain and distention
• Monitor for complications

Documentation

• Procedure report completion
• Photo documentation
• Pathology requisitions
• Follow-up instructions

Quality Metrics

Key Performance Indicators

• Cecal intubation rate >90%
• Adenoma detection rate targets

  • 25% for men

  • 15% for women

• Withdrawal time documentation
• Complication rate monitoring