IV DILTIAZEM (CARDIZEM) PROTOCOL

1.  For control of rapid ventricular response to atrial fibrillation or atrial flutter.
2. If HR greater than 120, and systolic BP greater than 100 mmHg (for Systolic BP less than 100 mmHg –notify MD before considering protocol).

a) Initial bolus –
-(1) 20 mg. IV over 2 minutes.
-(2) 10 minutes after initial bolus, if HR still greater than 120 and SBP greater than 100, repeat bolus 20 mg. over 2 minutes.
-(3) If HR remains greater than 120 Beats Per Minute after the second bolus, notify MD.

b) Infusion rate
-(1 ) Begin infusion rate at 10 mg/hour drip immediately after initial bolus. May adjust infusion rate hereafter from 5-15 mg/hour to maintain HR 70-110 BPM. (May increase rate 30 minutes after the previous rate if HR not controlled.)
-(2) May bolus 10 mg. IV over 2 minutes with each increase in infusion (if necessary) to maintain a heart rate of 70-110.

3. If patient converts to sinus rhythm:
Discontinue infusion and Notify MD

4. Discontinue bolus/infusion and notify MD if HR less than 60 Beats Per Minute, Systolic BP less than 90 mmHg, pauses greater than 2 seconds.