How to prepare for your appointment

Please do not eat for 4 hours before your infusion. Water and herbal teas are allowed. No caffeine, acidic drinks, or milk please. This is to minimize nausea during the infusion.

You might be able to eat during the infusion depending on how you feel. Please bring light snacks that are easy on your stomach. We have a fridge you may store food in for the day. 

Please do not wear nail polish or false nails. They may interfere with the equipment. If not done in advance, you may be required to remove them before the infusion starts.

Be sure to bring an updated list of medications, allergies, and medical symptoms.

We encourage you to bring comfortable clothes, slippers, blankets, and pillows from home if you would like. We want you to be very comfortable during your infusion.

Please layer your clothes so that we can keep you at a comfortable temperature.

Please bring any reading materials, soothing music with earphones, or other light entertainment to your appointment. Consider bringing meditation or relaxation aids.

Patients are not allowed to drive home after their infusion and must organize a safe and reliable ride home. The nurses can help you call for your ride near the end of the infusion, as an exact pick up time can vary.


What happens on the infusion day?

At the start of an infusion day, please check in at the front desk. The receptionist will ask you to pay any remaining balance for the infusion.

A nurse will meet with you to review your medications, answer any questions, and review the infusion consent form with you. Prior to starting the infusion, there is a brief assessment including an examination by the infusion doctor. If your symptoms have changed or if there is a concern, a further 12 lead heart tracing would be repeated to ensure no abnormal heart rhythms.

At the start of the infusion, we may administer medications for nausea or anxiety, especially if this is your first infusion. Other medications may be delivered throughout the infusion, as needed.

The infusion is delivered into the bloodstream via a catheter in the arm or hand. You will be seated in a reclining armchair.  Two nurses or one nurse and a physician will monitor your vital signs for the entire duration of the infusion. Please expect to be at the clinic for the majority of the day. The infusion itself occurs over approximately 8 hours.


What should I expect after the infusion begins?

The Infusion Room will be kept dark and quiet with the option of light therapeutic music. The nurses will support breath work, meditation, and relaxation techniques where appropriate. Please plan to utilize your own meditation or relaxation techniques to maximize therapeutic effect of ketamine infusion.

Nursing care and Monitoring

The nurses will not be providing any manual therapy, such as massage therapy. Any physical contact between you and a nurse is for adjusting the monitor or the IV. Sometimes the nurse might contact to your forehead or a place on your body that can help you feel reoriented to the room. This will be discussed and mutually agreed between you and the nurse before the infusion begins.

You will be connected to a heart monitor and the nurse will check your vital signs frequently. If you do not have nausea, the nurse may help you eat and drink. The nurse may also assist you to use bathroom or any time you are walking since you may feel dizzy or light headed.

Discharge

You must remain at CHANGEpain for at least 30 minutes after the infusion has stopped. During this time your nurse will check your vital signs and review your pain level and side effects.

The attending infusion doctor will reassess you and then you will be given recommendations and discharge instructions before you leave the clinic.

Ketamine Capsules

Ketamine capsules may be prescribed for you. These are used to help reduce possible withdrawal effects of stopping IV ketamine abruptly. These are usually prescribed if you have had more than 2 days IV ketamine infusions. You may start them in the night of discharge or the next day. If you are prescribed ketamine capsules, you will be contacted by MacDonald’s Pharmacy to pay for these prior to the start of your infusion. This cost is separate to the infusion fee.

Restrictions after IV ketamine infusion

You must be sure to have someone readily available to help care for and monitor you for 24 hours after the infusion. You are not allowed to drive for 24 hours after the infusion. After 24 hours, it is advised that you are cautious about driving or using heavy machinery. Please arrange for a safe and reliable ride to and from CHANGEpain clinic.

We recommend that you plan to rest for 48 hours after the infusion. Do not plan to return to work the next day. Please avoid heavy lifting or strenuous activities. After 24 hours, you may resume light activity as tolerated, however use caution against any injury.

Do not take extra sedative medications except with approval of your doctor. Please do not to consume any alcohol for 48 hours after an infusion, as it is a sedative. After 48 hours, please take caution when consuming alcohol.

You may continue using your normal medications unless advised otherwise by your infusion doctor.

If you go home with IV access (for multi-day ketamine infusions)

If the IV is wrapped with a bandage, do not remove the bandage unless you are having numbness or pain in the arm.

Try not to get the IV access wet. If the IV access is located in your hand, please do not soak that hand in water (for example, do not wash dishes). When taking a shower, we recommend covering the site with a plastic bag and using the other arm for washing.

If the IV falls out, please do not worry and apply pressure until any bleeding stops. Cover the site with a bandage, and we will restart another IV when you come in for your next infusion.

Often blood will “back up” in the IV tubing. Please do not worry, this is a common occurrence. We will flush the IV and check it before your next infusion.

If you experience pain, redness, or swelling at the IV insertion site, we recommend that you remove the IV, apply pressure, and cover with a bandage. Your nurse will explain this to you before you leave.

Possible Side Effects

Overall, this procedure has very few risks. However, as with any procedure, there are some risks and side effects that you should know about. Possible side effects include: increased pain from the injection (usually temporary), no relief from your usual pain, dizziness, fatigue, nausea, tingling around the mouth, allergic reaction, and slowed heart rate. Rarely, patients can get infection. Symptoms of an infection include bleeding, redness, swelling or pain where the infusion goes.

Like many medications, some patients will have side effects and others won’t.    The symptoms can be:

Mild:  Slight drowsiness, hypertension, headache, light-headedness, nausea

Moderate:   Marked sleepiness, nightmares dizziness, confusion, restlessness, vomiting

Very Rare:  Dissociative symptoms (Depersonalisation – a feeling that your body doesn’t quite belong to you or is disconnected from you or Derealisation – a feeling that you are disconnected from the world around you or “spaced out”)

Severe:    Very Rare: Seizure and heart rhythm disturbances.   

Side Effects

If Mild, If you have a headache, take Tylenol. If you have nausea, take ginger gravol. If you are lightheaded, lie down and rest.Drink fluids.

If Moderate/Severe: (if after 5pm)

Go directly to the emergency department if the symptoms are worsening

Contact CHANGEpain by phone voicemail (604-566-9101) or email (reception@changepain.ca) to update the clinicians of your symptoms (note email updates are not private).

Your CHANGEpain doctor or nurse will follow-up with you by phone the next day.

(If before 5pm)

Call CHANGEpain at to speak with your doctor or nurse.

604-566-9101  (between 8am and 5pm).   We may instruct you to be reassessed that day at CHANGEpain.

Follow up

Laboratory testing, including heart tracing and blood tests, must be repeated after the infusion. You must complete this testing within 4 weeks of your last infusion day.

You will be asked to report the result of the infusion in an online survey.

You will follow up with an infusion doctor within 4-6 weeks after the infusion. This appointment will be scheduled on the last infusion day.