Description and indication for use
Dobutamine is a synthetic catecholamine
(cardiac inotrope). It preferentially dilates the coronary beds and does not
cause vasodilation in renal and mesenteric areas. Dobutamine has less tendency to cause
arrythmias and less of a hypertensive effect than dopamine. It is used to increase myocardial
contractility and cardiac output.
Dose
IV infusion:
2.5 to 20 mcg/kg/minute starting at 5 micrograms/kg/min.
Reconstitution/Dilution
Vial = 250 mg in 20 mL solution (12.5 mg/mL).
Withdraw ordered dose and make up to
ordered infusion volume.
Usual order will be as follows:
|
Drug
|
How
to make up
|
Dose
equivalent
|
Dose
range
|
|
Dobutamine
|
60 mg/kg
in 50 mL glucose 10%
|
1 mL/hr = 20 micrograms/kg/min
|
4 - 20 micrograms/kg/min
|
Can also be made
up with glucose 5% solution.
Route and method of administration
Not for IV bolus or IM use.
IV Infusion:
Continuous IV infusion using a syringe pump
(preferably via a central line, but may be given peripherally if central access
is non-existent).
Side effects
May cause hypotension if patient
hypovolemic.
Tachycardia.
Arrythmias.
TISSUE ISCHAEMIA occurs with infiltration.
Hypertension.
Cutaneous Vasodilation.
Incompatibilities
Sodium bicarbonate and phenytoin.
Aminophylline.
Calcium gluconate (treatment
concentrations).
Diazepam.
Frusemide.
Digoxin.
Special precautions
Caution in patients with hypertension.
Hypovolaemia should be corrected before
dobutamine administration.
Do not bolus other drugs via dobutamine
infusion.
Solution may exhibit a pink color with no
significant loss of potency over 24 hours.
Nursing responsibilities
Carefully prime IV tubing.
USE SYRINGE PUMP.
Continuous blood pressure monitoring preferably
with an arterial line.
Continuously monitor heart rate and rhythm.
Record vital signs hourly.
Observe and measure urine output.
Observe IV site for inflammation and
extravasation of fluid, remove immediately if occurs.
Avoid interruption of infusion.
DO NOT ADMINISTER ANY BOLUS DOSES.
Change infusion fluid every 24 hours and
tubing every 3 days (as per RCH IV Line Protocol) ensuring that the 3-way tap
is turned off during syringe change to prevent any inadvertent bolus dose being
given.
Check that rate ordered corresponds with dose
required (micrograms/kg/min).