Liverpool Hospital ICU Guideline: Pharmacology Intensive Care Unit

Drug Guideline Title: Dobutamine

Summary: Dobutamine is a synthetic catecholamine that stimulates beta
receptors of the heart to produce mild chronotropic, hypertensive, arrhythmogenic
and vasodilative effects. It is used in the ICU for acute heart failure, cardiogenic
shock, pulmonary oedema and to increase cardiac output.

Approved by: ICU Director

Publication (Issue) Date: May 2014

Next Review Date: May 2017

Replaces Existing Drug Guideline: Dobutamine

Previous Review Dates: 2009, 2011

1. Introduction:
The risk addressed by this policy:

Patient Safety

The Aims / Expected Outcome of this policy:

Dobutamine will be administered safely and appropriately without any adverse

side effects.

Related Standards or Legislation

NSQHS Standard 1 Governance

National Standard 4 Medication Safety

Related Policies
 LH_PD2013_C03.01 Drug Administration
 LH_PD2010_C03.00 Drug Prescribing
 LH_PD2008_C03.12 Administration of IV Medication
 LH_PD2012_C03.05 Accountable Drugs – Schedule 8 (S8) and S4D

2. Policy Statement:
• All care provided within Liverpool Hospital will be in accordance with infection
control, manual handling and minimisation and management of aggression
guidelines.

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Liverpool Hospital ICU Guideline: Pharmacology Intensive Care Unit

• Medications are to be prescribed and signed by a medical officer/authorised

nurse practitioner (NP) unless required during an emergency.
• All drugs administered during an emergency (under the direction of a medical
officer/authorised nurse practitioner) are to be documented during the event,
then prescribed and signed following the event.
• Medications are to be given at the time prescribed (as close to the time as is
possible when multiple drugs require ‘same time’ administration and, when
the nurse is caring for more than one patient, recognition is given to a
possible short delay to administration – antibiotics and other lifesaving drugs
are to be prioritised) and are to be signed by the administering nurse.
• Parenteral medication prescriptions and the drug are to be checked with a
second registered or endorsed enrolled nurse prior to administration. The
“rights of drug administration” must be followed: right: patient, drug, dose,
route, administration, time, reason for the drug, documentation, education
and evaluation/outcome.
• Adverse drug reactions are to be documented and reported to a medical
officer.
• Medication errors are to be reported using the hospital electronic reporting
system: IIMS.
• Guidelines are for adult patients unless otherwise stated
• Dobutamine infusions may be titrated or weaned by an accredited Registered Nurse.
• Dobutamine infusions are not to be purged / bolused.
• Medical Officers must ensure that titration and/or weaning parameters are specified on
the management plan, and have been discussed with the nurse assigned to that patient.
• Dobutamine may be administered via a peripheral cannula or central line.
• Dobutamine MUST ALWAYS be administered via a dedicated lumen, and never
“piggybacked” with other drugs or fluids. Where multiple infusions are required, it may
be acceptable to administer dobutamine with other inotropes, via a three-way tap.
• Dobutamine infusions must be administered by syringe pump or infusion pump.

For the purposes of this Policy, an accredited RN is: a Registered Nurse (RN)
who has completed the required self directed learning packages and has been
accredited by a Clinical Nurse Educator / Consultant with the inotrope
competency tool, to administer/titrate inotropic drugs when caring for an Intensive
Care Unit (ICU) Patient. The Educator/Clinical Nurse Consultant may deem the
nurse competent if the nurse has previous documented experience/qualifications.

3. Principles / Guidelines

Actions1,2,3
• Dobutamine is a synthetic catecholamine and a direct acting inotrope.
• It stimulates the beta () receptors in the heart and produces mild
chronotropic, hypertensive, arrhythmogenic and vasodilative effects.
• -1 stimulation results in an increase in heart rate (mild), myocardial
contractility and excitability.
• -2 stimulation is minimal – may have some peripheral vasodilatation and
brochodilation.
• The onset of action is within 1-2 minutes, but with an infusion it may take up
to 10 minutes to obtain the peak effect.

Indications1,2,3
• Acute heart failure
• Cardiogenic shock
• To reduce preload and afterload in cardiogenic pulmonary oedema.
• To increase cardiac output, improve contractility and oxygen delivery.

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Liverpool Hospital ICU Guideline: Pharmacology Intensive Care Unit

Contraindications1,2,3
• Hypovolaemia
• Idiopathic hypertrophic subaortic stenosis
• Allergy to sulphites
• Hypersensitivity
• Previous anaphylactic reaction to dobutamine or any component of the
preparation

Precautions1,2,3
• In patients who are given beta-adrenergic receptor agonists the potency of
dobutamine may be decreased. This could potentiate the alpha agonist
effects such as hypertension and vasoconstriction. On the contrary, alpha-
adrenergic blockade may make the beta1 and beta 2 effects apparent,
resulting in tachycardia & vasodilatation.
• No improvement may be observed in the presence of severe valvular aortic
stenosis.
• Serum potassium levels should be monitored as dobutamine like other beta-
agonists can produce mild reduction in potassium concentration
• As with any inotrope, ECG and blood pressure should be continuously
monitored during administration of dobutamine.
• Dobutamine contains sodium metabisulfite, which may cause an allergic
response in patients with asthma
• Hypovolemia should be corrected before treatment with dobutamine is
commenced.
• Digoxin preparations should be administered prior to dobutamine when there
is atrial fibrillation with a rapid ventricular response
• Dosage should be titrated to avoid excessive increases in heart rate and
systolic blood pressure.

Significant Interactions4
• Concomitant use of dobutamine and nitroprusside results in a higher cardiac
output and, usually, a lower pulmonary wedge pressure than when either drug
is used alone.
• Small studies indicate that patients with heart failure treated with dobutamine
and glyceryl trinitrate will have, lower pulmonary wedge pressure than when
just using dobutamine & higher cardiac output than when just using glyceryl
trinitrate.

Adverse Effects1,2,3,4
• Tachycardia and increase in systolic blood pressure that nay be dose related.
• Increasing VEB’s in 5% of patients
• Hypotension
• Phlebitis may occur with infiltration into the tissues
• 1-3% of patients treated have experienced nausea, headache, angina,
nonspecific chest pain, palpitations, shortness of breath, skin rash, fever,
eosinophilia bronchospasm & isolated cases of thrombocytopenia
• Mild reduction in serum potassium concentrations

Presentation2
• Dobutamine 250mg vial (Protect from Light)

Administration Guidelines2,3,4,5
• Reconstitute vial with 10 mLs of water for injection, 0.9% sodium chloride
should not be used to reconstitute vial but may be used for further dilution
• Add 250mg dobutamine to 40mLs sterile 0.9% sodium chloride, to give a final
volume of 50ml and final concentration of 5mg/mL, or 5000micrograms/mL

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Liverpool Hospital ICU Guideline: Pharmacology Intensive Care Unit

• Desired dose range is 2.5-15micrograms/kg/minute

To calculate rate:
Dose (microgram/kg/min) x weight x 60) ÷ strength (micrograms/ml) = rate
(ml/hr)
e.g. 2.5 microgram/kg/min x 100 kg x 60 = 15 000 ÷ 5000 microgram/ml = 3
ml/hr

To calculate dose:
Strength (micrograms/ml) x rate (ml/hr) ÷ weight ÷ 60 = dose
(microgram/kg/min) delivered
e.g. 5000 x 3 ÷ 100 kg ÷ 60 = 2.5 micrograms/kg/min

• Titrate the infusion using parameters which have been discussed and
documented on the management plan with the Medical Officer; including:
 Mean arterial blood pressure
 Cardiac index
 Pulmonary capillary wedge pressure (PCWP)
 Systemic vascular resistance

• If necessary, increase the infusion by 1 microgram/kg/min every 5 minutes,

while closely monitoring the patient for the desired effect.
• Hypotension may follow the administration of dobutamine due to the -2
mediated vasodilation.
• Added volume as fluid bolus may be needed to maintain an adequate
preload. If patient has invasive hemodynamic monitoring such as PA catheter
or PiCCO then titrate the volume loading to the measured filling pressures.

Clinical Considerations2,3,4,5
• Use of dobutamine may produce mild reduction in serum potassium, monitor
electrolyte levels, replace potassium as indicated.
• Continuous monitoring of ECG and blood pressure is necessary during
administration of dobutamine.
• When clinically indicated invasive hemodynamic monitoring with a pulmonary
artery catheter or PiCCO should be used to measure cardiac output /index,
filling pressure, SVR and workload of the heart.
• Because of its short half-life, it must be administered as a continuous infusion
• Daily 12-lead ECG should be attended.
• Strict fluid balance should be maintained and daily weight attended.

Weaning2,3,4
• Commenced when the patient has been stable for approximately 24 hours or
as clinically indicated.
• Wean the rate of infusion to desired parameters, while observing the patient
closely for signs of deterioration, especially recurrent pulmonary oedema.
• Weaning dobutamine at a low dose may be facilitated by administration of
alternative agent, for example, commencing oral agents such as ACE
inhibitors.

4. Performance Measures
All incidents are documented using the hospital electronic reporting system:
IIMS and managed appropriately by the NUM and staff as directed.

5. References / Links
1. The Society of Hospital Pharmacists of Australia 2011, The Australian Injectable Drugs
th
Handbook, 5 Edition, SHPA publications, Australia.

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Liverpool Hospital ICU Guideline: Pharmacology Intensive Care Unit

2. MIMS Online, CIAP: NSW Health Department, Copyright MIMS Australia Pty Ltd 2013.
http://www.mims.hcn.net.au/. http://www.mims.hcn.net.au/
th
3. eTherapeutic Guidelines: CIAP 2013, http://www.tg.org.au/, viewed 11 Dec 2013
th
4. Thomas Reuters, Micromedex 2.0, http://www.micromedex.com/, viewed 11
December 2013.
5. Fairfield Hospital, (2013). Clinical Policy Manual: DOBUTAMINE.
FRF_GL2013_DRUG004

Author: CNC – ICU (S. Shunker);

Reviewers: ICU – CNC, CNE, NM, NUM, Staff Specialists, CNS ‘s, Medical
Director, Pharmacist
Endorsed by: A/ Proff M. Parr, Director ICU.

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 Liverpool Hospital ICU Guideline: Pharmacology Intensive Care Unit

Appendix 1 – Dobutamine Rate Calculation Table, correct to 1 decimal place

Mcg/kg/min 50kg 55kg 60kg 65kg 70kg 75kg 80kg 85kg 90kg 95kg 100kg 105kg 110kg 115kg 120kg
1.0 0.6 0.7 0.7 0.8 0.8 0.9 1.0 1.0 1.1 1.1 1.2 1.3 1.3 1.4 1.4
1.5 0.9 1.0 1.1 1.2 1.3 1.4 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.1 2.2
2.0 1.2 1.3 1.4 1.6 1.7 1.8 1.9 2.0 2.2 2.3 2.4 2.5 2.6 2.8 2.9
2.5 1.5 1.7 1.8 2.0 2.1 2.3 2.4 2.6 2.7 2.9 3.0 3.2 3.3 3.5 3.6
3.0 1.8 2.0 2.2 2.3 2.5 2.7 2.9 3.1 3.2 3.4 3.6 3.8 4.0 4.1 4.3
3.5 2.1 2.3 2.5 2.7 2.9 3.2 3.4 3.6 3.8 4.0 4.2 4.4 4.6 4.8 5.0
4.0 2.4 2.6 2.9 3.1 3.4 3.6 3.8 4.1 4.3 4.6 4.8 5.0 5.3 5.5 5.8
4.5 2.7 3.0 3.2 3.5 3.8 4.1 4.3 4.6 4.9 5.1 5.4 5.7 5.9 6.2 6.5
5.0 3.0 3.3 3.6 3.9 4.2 4.5 4.8 5.1 5.4 5.7 6.0 6.3 6.6 6.9 7.2
5.5 3.3 3.6 4.0 4.3 4.6 5.0 5.3 5.6 5.9 6.3 6.6 6.9 7.3 7.6 7.9
6.0 3.6 4.0 4.3 4.7 5.0 5.4 5.8 6.1 6.5 6.8 7.2 7.6 7.9 8.3 8.6
6.5 3.9 4.3 4.7 5.1 5.5 5.9 6.2 6.6 7.0 7.4 7.8 8.2 8.6 9.0 9.4
7.0 4.2 4.6 5.0 5.5 5.9 6.3 6.7 7.1 7.6 8.0 8.4 8.8 9.2 9.7 10.1
7.5 4.5 5.0 5.4 5.9 6.3 6.8 7.2 7.7 8.1 8.6 9.0 9.5 9.9 10.4 10.8
8.0 4.8 5.3 5.8 6.2 6.7 7.2 7.7 8.2 8.6 9.1 9.6 10.1 10.6 11.0 11.5
8.5 5.1 5.6 6.1 6.6 7.1 7.7 8.2 8.7 9.2 9.7 10.2 10.7 11.2 11.7 12.2
9.0 5.4 5.9 6.5 7.0 7.6 8.1 8.6 9.2 9.7 10.3 10.8 11.3 11.9 12.4 13.0
9.5 5.7 6.3 6.8 7.4 8.0 8.6 9.1 9.7 10.3 10.8 11.4 12.0 12.5 13.1 13.7
10 6.0 6.6 7.2 7.8 8.4 9.0 9.6 10.2 10.8 11.4 12.0 12.6 13.2 13.8 14.4
10.5 6.3 6.9 7.6 8.2 8.8 9.5 10.1 10.7 11.3 12.0 12.6 13.2 13.9 14.5 15.1
11.0 6.6 7.3 7.9 8.6 9.2 9.9 10.6 11.2 11.9 12.5 13.2 13.9 14.5 15.2 15.8
11.5 6.9 7.6 8.3 9.0 9.7 10.4 11.0 11.7 12.4 13.1 13.8 14.5 15.2 15.9 16.6
12.0 7.2 7.9 8.6 9.4 10.1 10.8 11.5 12.2 13.0 13.7 14.4 15.1 15.8 16.6 17.3
12.5 7.5 8.3 9.0 9.8 10.5 11.3 12.0 12.8 13.5 14.3 15.0 15.8 16.5 17.3 18.0
13.0 7.8 8.6 9.4 10.1 10.9 11.7 12.5 13.3 14.0 14.8 15.6 16.4 17.2 17.9 18.7
13.5 8.1 8.9 9.7 10.5 11.3 12.2 13.0 13.8 14.6 15.4 16.2 17.0 17.8 18.6 19.4
14.0 8.4 9.2 10.1 10.9 11.8 12.6 13.4 14.3 15.1 16.0 16.8 17.6 18.5 19.3 20.2
14.5 8.7 9.6 10.4 11.3 12.2 13.1 13.9 14.8 15.7 16.5 17.4 18.3 19.1 20.0 20.9
15.0 9.0 9.9 10.8 11.7 12.6 13.5 14.4 15.3 16.2 17.1 18.0 18.9 19.8 20.7 21.6
Taken from Fairfield Hospital, (2013). Clinical Policy Manual: DOBUTAMINE.
FRF_GL2013_DRUG004

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