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Drugs - Dobutamine

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For use in Ward 23b Intensive Observation Area (IOA)

Purpose of guideline

This guideline covers the use of a dobutamine infusion in the ward setting.

Use of dobutamine and the appropriate dose is to be determined by the consultant cardiologist and/or cardiac surgeon only.

If a dobutamine infusion in the ward setting is to be considered in a neonate (< 1 month of age) it must be done following consultation with the on call cardiologist and PICU.

Action

Dobutamine is a synthetic catecholamine and it is a direct acting inotropic agent whose primary activity results from stimulation of cardiac adrenergic receptors acting primarily on β 1 receptors. Dobutamine increases stroke volume and cardiac output and decreases ventricular filling pressure and total systemic and pulmonary vascular resistances. It produces comparatively mild chronotropic, hypertensive, arrhythmogenic, and vasodilator effects. Like all inotropic agents, dobutamine hydrochloride increases myocardial oxygen consumption. Dobutamine hydrochloride also increases coronary blood flow and myocardial oxygen supply4.

Indications

Administered to children with low-output hypoperfusion states resulting from decompensated heart failure, cardiac surgery, and cardiogenic and septic shock4.

Dose and prescription

Dose

Starting dose is 5 micrograms/kg/minute administered by continuous IV infusion therapy3. Higher doses must be discussed with a cardiologist. 

NB: Central line administration is preferred. Can give peripherally - recommended dilution is 5mg/ml. Higher concentrations can be used at prescriber discretion

Prescription

To be prescribed on the Fluid balance chart and must include:

  • Amount of dobutamine to add, in mg
  • Diluent and final volume of infusion.
  • Dose in micrograms/kg/minute.
  • Rate in mls/ hour
  • The target B.P. (systolic and diastolic)

Administration

  • Give as infusion
  • Compatible fluids for further dilution - sodium chloride 0.9%, glucose 5%

Infusion preparation for child UNDER 30 kg

  • Dilute 15mg/kg dobutamine to total volume of 50ml with sodium chloride 0.9% or glucose 5%. 
  • Check your preparation using the example below:
Example for child weighing 5kg
Dose (micrograms/kg/min) 5 micrograms/kg/minute
Amount of dobutamine to be added 15mg x 5 kg = 75mg
Diluent  (type and final volume) Glucose 5% to make up to 50ml
Rate  (in mls/ hour) 1ml/hour=5 micrograms/kg/minute

Infusion preparation for child 30 kg and OVER

  Refer to PICU Cardiovascular Drug Infusion Chart

Administration continued...

  1. Administer by IV infusion via a syringe driver only
  2. Do not give as bolus or undiluted.
  3. Central line administration is preferred but can give peripherally. NB recommended dilution for peripheral administration is 5mg/mL. Higher concentrations can be used at prescriber discretion
  4. Correct Hypovolaemia before commencing administration
  5. Do not use a dobutamine line to co-administer other infusions
  6. Do not flush the line containing dobutamine
  7. Prepare a fresh solution for administration every 24 hours.

Observation and documentation

  1. Continuous cardiac monitoring.
  2. Monitor and document the following:
    1. Heart rate (HR)
    2. Blood pressure (BP) at least hourly, or as specified by the prescriber.
    3. Oxygen saturations (Sp02).
    4. IV site, when used peripherally. Avoid extravasation.
    5. Adverse reactions.
  3. The dose in micrograms/kg/minute is recorded on the patients observation chart hourly.
  4. The volume of the infusion administered is recorded on the fluid balance chart hourly.
  5. It is recommended that treatment with dobutamine be discontinued gradually. Do not stop abruptly. Weaning is by 1 microgram/kg/minute until infusion is discontinued.
  6. Weaning of dobutamine is done with continuous assessment of the patient's haemodynamic status.

Special considerations

Handover between staff is important: discussion with medical staff needs to take place at both morning and evening handover and also between nursing staff at each shift change:

  • To confirm that the infusion is to continue
  • To check the current rate
  • To independently double check the infusion dose calculation by both nursing staff members

Contraindications and precautions

Contraindications

  1. Impaired ventricular filling and ventricular outflow tract obstructions such as: left sided lesions, coarctation, critical aortic stenosis, hypertrophic obstructive cardiomyopathy.
  2. Hypersensitivity to sodium bisulfite (metabisulphite) (more common in asthmatics)

Precautions

  1. Hypovolamaemia - should be corrected before commencing dobutamine.
  2. Arrhythmias.
  3. Severe hypotension.

Possible Adverse effects

  1. Nausea, hypotension, hypertension (marked increase in systolic blood pressure indicates overdose), arrhythmias, dyspnoea, headache, fever.
  2. Extravasation results in local inflammation and pain, with possible necrosis.

Presentation

Dobutamine HCL concentrated solution for infusion 250mg/20mL.

For detailed information about dobutamine hydrochloride, including clinical pharmacology, go to the New Zealand Medsafe Data Sheet. Information is also available on the NZFC.

References

  1. BNF for children 2011-2012. London: Pharmaceutical Press, 2011.
  2. Phelps SJ, Hak EB, Crill CM, (eds.). Pediatric Injectable Drugs, The Teddy Bear Book (9th ed.). Bethesda: American Society of Health-System Pharmacists, 2010.
  3. Woods, DJ (editor), New Zealand Formulary for Children [Internet]. 2016 [updated 2016 March 1; 2015 Sept 1; cited 2016, March 18]. Available from: www.nzfchildren.org.nz
  4. Dobutamine (Dobutamine-Claris) [New Zealand data sheet] AFT Pharmaceuticals Ltd [updated 25/09/2015]. Available from URL: http://www.medsafe.govt.nz

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Document Control

  • Date last published: 29 July 2016
  • Document type: Drug Dosage Guideline
  • Services responsible: Paediatric Cardiology
  • Intended users: Ward 23B Intensive Observation Area (IOA)
  • Author(s): John Stirling, Marion Hamer, Brenda Hughes
  • Editor: Marion Hamer
  • Review frequency: 2 years