IV Access in Ketamine Infusion Therapy

I.V. Access For Ketamine Infusion

informed Consent

When you have made the decision to get IV Ketamine; you need to make an educated (informed) decision as to how the Ketamine should be infused into your body.  This decision needs to be made in conjunction with your doctor.  

For the most part, when you enter into treatment with Ketamine for RSD, it is an ongoing treatment if it is successful.  This should be taken into consideration when deciding what type of IV access you want.

If your first Ketamine treatment is outpatient and you are not sure how it will work for you; as Ketamine is not always the best treatment for everyone, then a traditional peripheral IV may be your best access.  The peripheral IV must be changed every 72 hours (in most institutions).  When you are getting outpatient treatments, most facilities will allow you to go home with it in place for three days of outpatient infusions.  They will take steps to protect the catheter when you are at home so that it doesn’t get dislodged.  There is always the chance that it will become dislodged and need to be replaced.  Lidocaine (a numbing medication) can be used when a peripheral IV is started.  There have been some cases where the placement of an IV has caused spread of RSD.  I could not find any percentages of cases where the spread of RSD was associated with an IV stick.  Here is what a peripheral IV looks like:

http://en.wikipedia.org/wiki/File:Intravenous_therapy_2007-SEP-13-Singapore.JPG

If your first Ketamine treatment is inpatient; you will most likely be getting follow up “booster” infusions (infusions in an outpatient setting).  In this case, it makes more sense that you get a more permanent access.  One form of permanent IV access is a mediport/portacath.  This is surgically implanted, usually in your chest just under the skin, and is accessed by a special needle called a Huber needle.  When the port is not being used, it is just a slight bulge under the skin.  When it is being used, the Huber needle is inserted into a reservoir just under the skin and secured with a clear dressing.  The Huber needle can stay in place for up to seven days.  The risk of infection is very low with this type of device.  It does require monthly flushing by a nurse to keep it patent.  This can be done in your doctor’s office.  Here is some information on the mediport/portacath:

http://en.wikipedia.org/wiki/Port_(medical)

Some Benefits Of The Mediport/Portacath System Include:

• It minimizes damage to veins, muscle and skin tissue by allowing the medication to be diluted faster in the larger veins
• It allows for a single location that your doctor can use to infuse Ketamine and/or take blood directly from large veins.
• It avoids the risk and pain to the RSD patient of looking for new veins each time the patient needs an infusion or have a blood sample taken.
• Scar tissue builds up over time at the Mediport/Portacath location making each needle penetration less painful over time.
• Minimizes risk of infection over a temporary central line.
• Can be left in place for years with proper maintenance (monthly flushing)

There are other central line options that include a PICC line (peripherally inserted central line) which is inserted in the arm, a Hickman, and a non-tunneled central line which are also inserted in the chest area.  Here is a Wikipedia explanation of some other types of central lines.  Most of these types of central lines are temporary in nature and are removed before you are discharged from the hospital or are left in for only a short time after discharged unlike the Mediport/portacath which can be left in place for years.

http://en.wikipedia.org/wiki/Central_venous_catheter

As you can see, if you are going into the hospital for inpatient Ketamine therapy, how the Ketamine is going to be infused is something that you need to think about and discuss with your physician BEFORE you are admitted.  You don’t want to find out the morning of admission that you are getting a different type of IV access than you thought or that you are getting removable sutures rather than dissolvable sutures and steri-strips.  You don’t want to find out upon discharge when you are sleepy and possibly still disoriented that your IV access is being removed; when you thought that it was staying in place for future infusions.  

This is just another part of your informed decision that you need to make when planning your RSD Ketamine treatment.