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Policies,Clinical,UWHC Clinical,Department Specific,Emergency Department

Ketamine: Low Dose IV Ketamine with Pain Management for Adult Patients in the ED (31.1)

Ketamine: Low Dose IV Ketamine with Pain Management for Adult Patients in the ED (31.1) - Policies, Clinical, UWHC Clinical, Department Specific, Emergency Department

31.1


NURSING PATIENT CARE POLICY & PROCEDURE






Effective Date:
Month 12/1/2013

ED Policy Manual

Policy #: 31.1

Original
X Revision
December 15, 2016

Page
1
of
_3_

Title: Ketamine: Low dose IV ketamine
with Pain management for adult patients
in the ED


I. PURPOSE
Low dose ketamine has been shown to be an effective adjunct agent in the treatment of
pain. It has been shown to decrease opiate consumption, and provide pain relief for opiate
tolerant patients. However, given its use as an anesthetic agent at larger doses low dose
administration must be clearly defined to avoid adverse effects. This policy defines the
appropriate ordering, dosing, administration and monitoring for low dose ketamine use in
the emergency department (ED).


II. POLICY

A. Use of low dose ketamine bolus dosing in the emergency department may be used outside
of 8.38 UWHC Adult Sedation policy if all of the following are met:
1. The dose is in the range of 0.1-0.3 mg/kg with a maximum of 20 mg given as a
single dose.
2. The intention is to treat moderate to severe pain.
3. The patient is an adult
4. Pain is reassessed after administration in accordance with hospital
administrative policy 8.76 Pain Management
5. Repeat doses are administered no sooner than every 1 hour

III. PROCEDURE

A. Ordering
1. When low dose ketamine is ordered for a patient in the ED the prescriber should
list the indication in the order. If the reason is not specifically stated the ED RN
should clarify the intent with the prescriber.
2. Avoid ketamine use in patients with evidence of traumatic brain injury or
increased CSF pressures, poorly controlled hypertension not attributable to pain,
ischemic heart disease, unexplained tachycardia, severe psychiatric disorders

B. Order verification
1. The ED RN should verify the dose does not exceed the lesser of 0.3 mg/kg or 20
mg.


2. Consultation with ED pharmacist is recommended but not required
C. Administration
1. Only the 50 mg/ml concentration is to be used for IV administration.
2. Administration should occur over no less than 1 minute as more rapid
administration may result in respiratory depression and hypertension.
D. Monitoring
1. Common adverse effects of low dose ketamine include:
a. Dizziness
b. Changes in vision
c. Changes in mood including euphoria and dysphoria
d. Nausea
e. Headache
f. Elevated blood pressure
g. Elevated heart rate
2. Discharge of a patient after receiving low dose ketamine should follow ED
policy 6.0 Safe Discharge From the ED

E. Redosing
1. Redosing has not been thoroughly evaluated. Based on the half–life of the drug
it should not be redosed sooner than 1 hour after the initial dose.




IV. UWHC CROSS REFERENCE

A. 6.0 Safe Discharge From the ED
B. 8.38 UWHC Adult Sedation policy
C. 8.76 Hospital Administrative Policy - Pain Management


V. REFERENCES

A. Galinski M, Dolveck F, Combes X, et al. Management of severe acute pain in emergency
settings: ketamine reduces morphine consumption. Am J Emerg Med. 2007;25(4):385-
390
B. Herring AA, Ahern T, Stone MB, et al. Emerging applications of low-dose ketamine for
pain management in the ED. Am J Emerg Med. 2013;31(2):416-419.
C. Jennings PA, Cameron P, Bernard S. Ketamine as an analgesic in the pre-hospital setting:
a systemic review. Acta Anaesthesiol Scand. 2011;55(6):638-643
D. Jennings PA, Cameron P, Bernard S, et al. Morphine and ketamine is superior to
morphine alone for out-of-hospital trauma analgesia: a randomized controlled trial. Ann
Emerg Med. 2012;59(6):497-503
E. Johansson P, Kongstad P, Johansson A. The effect of combined treatment with morphine
sulphate and low-dose ketamine in a prehospital setting. Scand J Trauma Resusc Emerg
Med. 2009;17:61
F. Ketamine In: DRUGDEX® System (internet database). Thomson Micromedex,
Greenwood Village, Colorado, USA. Available at http://www.thomsonhc.com (cited July


9, 2013)


VI. REVIEWED BY
ED Pharmacist
ED Clinical Nurse Specialist
ED Clinical Operations Committee

SIGNED BY

Anne LeGare RN, MS, CEN
Co-Nurse Manager, Emergency
Department
Valerie Mack RN, BSN, CEN, CPEN
Co-Nurse Manager, Emergency
Department

Joshua Ross, MD
Clinical Vice Chair
Emergency Department