How to prepare for your appointment

If this is your first SC lidocaine infusion, be prepared to stay in the clinic for 30 minutes.

 If this is a repeat infusion, you may only be in our clinic for 30 minutes. Please wear clothing that can easily expose the abdomen, such as zippered sweaters or loose shirts.


On the Day of Your Infusion

At the start of an infusion day, please check in at the front desk. The receptionist will take payment for the infusion at this time.

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 may be a brief assessment including an exam 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.

You will watch an instructional video with your nurse to teach you how to use your infuser.

The infusion is delivered under the skin (subcutaneously) via a catheter into the abdomen. You will be asked to remain in our clinic until deemed safe to go home. A nurse or infusion doctor will check in on you throughout the monitoring period.

You will be discharged by a nurse or doctor and given home care instructions.


What should I expect after the infusion begins?

At some time during the infusion or after it has finished, you may notice that your pain may be gone or considerably less. This is due to the local anaesthetic and may last from a few hours to weeks.

The infusion time is expected to be between 1-4 days depending on the amount and concentration of lidocaine you are receiving. You can adjust the flow of lidocaine using the clamping system.

For some, the volume of the lidocaine may absorb slowly and therefore form a numbed skin area around the site of the catheter. This will eventually flatten out and is not a concern if it is not painful.

What are my restrictions while the lidocaine infusion is running?

Do not drive. You must not drive during the infusion unless the infuser is clamped until you arrive at your destination. It is preferred that you arrange to have someone escort you home. You should be accompanied by someone for the remainder of the day to monitor you.

Do not do strenuous activity. We advise the patients to take it easy during and for a day or so after the procedure. You may perform some light activities if tolerated.

Do not take extra sedative medications except with approval of your doctor. Do not drink any alcohol.

How do I clamp the tubing if I need to stop the flow of lidocaine?

How do I clamp the tubing if I need to stop the flow of lidocaine?

The Baxter Bottle delivers medication at approximately 5ml per hour. To stop the flow, simply use the white small clamping clip your physician or nurse provided to you during your appointment.

The clamp allows the infuser to be turned ON and OFF easily. Generally, an ON and OFF schedule allows people to minimize side effects, though some people can tolerate a continuous infusion. The infusion should be clamped and turned off at all times side effects are experienced.

A typical starting infuser schedule:

·      2 hours ON, 1 hour OFF during daytime

·      OFF if concerned about side-effects

During the first SC lidocaine session, we suggest that it is turned OFF during the night until we have more experience with how it affects you.

If you are not running the infusion during the night, you can choose to disconnect the infuser bottle for comfort when sleeping. To do this, disconnect the flow restrictor valve from the tubing and replace each end with one of the caps provided. Reattach the bottle in the morning.

How do I care for the infuser pump during the infusion?

Keep the all components of the infuser, caps, and catheter clean.

The infuser may be placed in any convenient place where there is no tension on the tubing and where the bottle is at the same level of the catheter to ensure consistent flow rate.  A shirt pocket or waist pack works well. We suggest wearing the bottle underneath a sweater to prevent the tubing from getting caught on objects like doorknobs.

Shower/bathing restrictions: do not get the injection site wet. When the tape gets wet, the catheter may fall out. Brief showers are recommended. Before showering, we recommend you disconnect the bottle and replace each end with the caps. Place a towel over insertion site to keep it dry while showering.

It is important keep the infusion away from heat sources (e.g. hot water bottle or electric heating pad) as this might cause the heat activated dispenser to deliver the lidocaine too quickly. The Baxter bottle could potentially expand and rupture if placed next to an excessive heat source. Your normal skin temperature regulates the flow of the infusion, so the heat activated flow restrictor needs to touch your skin.

If the reservoir tube does not appear to be emptying, the tubing may be kinked.  If emptying is faster than expected, it is not a problem unless you have side effects. Clamp the infusion if side effects occur.

The plastic catheter is not likely to cause bleeding but may kink and stop or slow down the infusion.  If this happens towards the end of the infusion, remove the catheter.

How do I remove the infuser?

When the inner yellow reservoir tube appears straight, it is empty. Depending on the infusion rate and the ON/OFF schedule, it may take 1-4 days to empty.

There is no need to come to the clinic to remove the infuser. Simply remove the tape and gently pull out the catheter. Apply pressure for 3 minutes or until any bleeding stops, then apply a band aid. 

You may dispose of the entire unit and tubing in the garbage.  There are no sharp needles.

If it malfunctions and you remove it, store the bottle in the fridge and contact our clinic.

If you have any questions or concerns about the infusion, please contact our front desk.

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 to lidocaine and slowed heart rate. Rarely, patients can get infection.  Symptoms might 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, slight metallic taste, headache, redness (mild skin irritation) or numbness (direct anaesthetic effect to the skin), mild swelling (is accumulation of the fluid) at the skin catheter insertion site.

Moderate: Marked sleepiness, strong metallic taste, dizziness, numbness around mouth and tongue. (Very rare)

Severe: Moderate symptoms that continue or worsen after the infusion has been stopped for 15 to 30 minutes. (Very rare)

Mild Side Effects

·  Continue with infusion.

·   If you have a headache, take Tylenol

·   If redness is mild, show your physician at the next appointment or take a picture. If redness is severe, painful, or itchy, remove the catheter and inform CHANGEpain.

·   If numbness at the skin, no action needs to be taken

If swelling is noted, but not painful, no action needs to be taken and observe for flattening of the area as the anaesthetic is absorbed with time. If swelling is painful, remove the catheter and inform CHANGEpain.

Moderate Side Effects

·  Stop the infusion for 15 to 30 minutes by clamping the tubing as we showed you during your appointment.

·   Call CHANGEpain at to speak with your doctor or nurse. 604-566-9101 (from 9am to 5pm)

·   If your symptoms subside, the CHANGEpain nurse or doctor will inform you to restart with advice to clamp the infusion every 3-8 hours and to stop it at bedtime and restart it the next morning.

Next day - call CHANGEpain to report your symptoms.

Severe Side Effects

·   Call CHANGEpain to speak with your doctor or nurse. 604-566-9101 (from 9am to 5pm)

·   We may instruct you to keep it clamped for 2 hours and retry again OR pull out the infusion and dispose of the Baxter bottle and tubing and follow-up with the doctor at the next scheduled appointment.

Be reassessed that day at CpC or at your nearest emergency department

Infection

If bleeding occurs, remove the catheter and apply pressure to the site until the bleeding stops.

·      Call CHANGEpain to speak with your doctor or nurse. 604-566-9101  (from 9am to 5pm)

If the redness, swelling or pain does not subside in 2 days call CHANGEpain to report the problem.Visit your family doctor or CHANGEpain for assessment and treatment of the possible infection.

What if I have moderate or severe side effects after CHANGEpain is closed at 5pm?

1.     Stop the infusion by clamping the tubing

2.     Do not remove the unit unless the symptoms are getting worse

3.     Go directly to the emergency department if the symptoms are worsening

4.     Contact CHANGEpain by phone voicemail or email to update the clinicians of your symptoms (note email updates are not private).

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

Follow up

Patients will report the result of the infusion in an online survey. Follow ups will be scheduled within 4-6 weeks after the infusion.