Download Corvert ibutilide Atrial Fibrillation Flutter Protocol

PLACE LABEL HERE
CORVERT (ibutilide)
ATRIAL FIBRILLATION / FLUTTER
PROTOCOL
The following orders will be implemented per physician order of this protocol.
Orders with a “” are indicator choices and are NOT implemented unless checked.
1.
2.
3.
4.
Patient’s Actual Weight _________ kg
Restricted to Cardiologists and Emergency Department (ED) Physicians
Physician or assigned midlevel to be present during infusion.
Restricted to ICU, IMCU, PCU, ED, ARU, 5N
5.
Pre-Infusion Check List
Nurse to confirm that all questions below are answered “yes”. If “No” answer, follow orders as indicated in the chart
below. Corvert (ibutilide) may only be administered if all below questions are answered with a “Yes”:
Yes
Requirements Prior to Administration

Is the Potassium (K) level > 4 within the
past 24 hrs?

Is the Magnesium (Mg) level > 2 within the
past 24 hrs?

Is 12-lead EKG in place and to be
performed for baseline and during Corvert
(ibutilide) infusion and cardiac monitoring
for a minimum of 4 hrs after administration?




Response if No:
DO NOT ADMINISTER CORVERT (ibutilide)
Draw stat potassium level
If level < 4, call physician for replacement orders
prior to administration of Corvert (ibutilide) and
recheck potassium level 1 hr after replacement
completed
Draw stat magnesium level
If level < 2, call physician for replacement orders
prior to administration of Corvert (ibutilide) and
recheck Mg level 1 hr after replacement completed

Continuous cardiac monitoring for any arrhythmia
activity or persistent QTc prolongation

Is an ACLS certified nurse or physician
present to monitor patient during and
following Corvert (ibutilide) administration?

Transfer patient to an appropriate unit described in
#4 above

Physician or midlevel documented baseline
QTc by signing EKG and approved to
administer Corvert (ibutilide).

Have physician or midlevel monitor and document
QTc on baseline EKG.

Confirmed that patient is NOT currently or
has previously taken any of the following
medications: amiodarone, dronedarone,
quinidine, procainamide, disopyramide,
sotalol, dofetilide, flecainide or propafenone
of other drugs known to prolong QT
interval.

If currently or previously taken a medication listed to
the left, date last taken__________________

Physician was informed (Dr._________________,
date/time________) and approved to administer.

Notify physician if patient has converted and no
longer in atrial fibrillation

Is the patient still in atrial fibrillation
immediately prior to administration of
Corvert (ibutilide)?
Copy to pharmacy
*3-21578*
FORM 3-21578 REV. 02/2016
Page 1 of 2
PLACE LABEL HERE
CORVERT (ibutilide)
ATRIAL FIBRILLATION / FLUTTER
PROTOCOL
The following orders will be implemented per physician order of this protocol.
Orders with a “” are indicator choices and are NOT implemented unless checked.
Corvert Dose and Administration:
6.
Give Magnesium Sulfate 2 Gm IVPB over 10 minutes immediately prior to Corvert administration unless
magnesium level > 3 or dialysis patient.
7.
12-lead EKG monitoring during infusion.
8.
Corvert (ibutilide) Dosing:
 Patient’s weight >65 kg, give Corvert (ibutilide) 1 mg, slow IV push over 10 minutes
 Patient’s weight 60 kg - 65 kg, physician to evaluate and determine best dosing regimen:
 give Corvert (ibutilide) 1 mg, slow IV push over 10 minutes
 give Corvert (ibutilide) 0.01 mg/kg, slow IV push over 10 minutes
 Patient’s weight < 60 kg, give Corvert (ibutilide) 0.01 mg/kg, slow IV push over 10 minutes
Corvert Infusion Monitoring Check List
9.
Nurse to confirm that all questions below are answered “yes”. If “No” answer, follow orders as indicated in the chart
below.
Yes
Requirements During and After Administration

Check QTc interval at 5 minutes into Corvert (ibutilide)
administration by a 12-lead EKG and copy in medical
record.
Is QTc < 500 ms at 5 minutes into infusion?

Check QTc interval at the end of Corvert (ibutilide)
administration by a 12-lead EKG and copy in medical
record.
Is QTc < 500 ms at end of infusion?

The following medications are not currently ordered:
amiodarone, dronedarone, quinidine, procainamide,
disopyramide, sotalol, dofetilide, flecainide or
propafenone within 4 hours post Corvert
administration or other QT prolonging drugs.
Response if No:
DO NOT ADMINISTER CORVERT (ibutilide)

If QTc > 500 ms, notify ordering physician
immediately and stop Corvert (ibutilide)
infusion

If QTc > 500 ms, notify ordering physician
immediately

Confirm with physician. Risk may outweigh
benefit by prolonging QTc interval and risk of
torsade.
4 Hour Post- Infusion Monitoring
10. Continuous cardiac monitoring 4-hours post infusion.
11.  Give additional Magnesium 2 Gm IVPB over 1 hour post infusion Corvert
12. Monitor for QTc prolongation > 500 ms, V-tach, new onset PVCs, or bradycardia < 50 bpm. Run a 12-lead EKG and
call physician if any develop.
13. At end of 4 hours post infusion, run final 12-lead EKG and have physician review and document final rhythm.
______________
Date
________________
Time
_________________________________
Physician Signature
___________
PID Number
Copy to pharmacy
FORM 3-21578 REV. 02/2016
Page 2 of 2