Dobutamine for paediatric cardiology
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.
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
Administer by IV infusion via a syringe driver only
Do not give as bolus or undiluted.
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
Correct Hypovolaemia before commencing administration
Do not use a dobutamine line to co-administer other infusions
Do not flush the line containing dobutamine
Prepare a fresh solution for administration every 24 hours.
Observation and documentation
Continuous cardiac monitoring.
Monitor and document the following at least hourly or as specified by the prescriber:
Heart rate (HR)
Blood pressure (BP).
Oxygen saturations (Sp02).
IV site, when used peripherally. Avoid extravasation.
Adverse reactions.
The dose in micrograms/kg/minute is recorded on the patients observation chart hourly.
The volume of the infusion administered is recorded on the fluid balance chart hourly.
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.
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
Impaired ventricular filling and ventricular outflow tract obstructions such as: left sided lesions, coarctation, critical aortic stenosis, hypertrophic obstructive cardiomyopathy.
Hypersensitivity to sodium bisulfite (metabisulphite) (more common in asthmatics)
Precautions
Hypovolamaemia - should be corrected before commencing dobutamine.
Arrhythmias.
Severe hypotension.
Possible adverse effects
Nausea, hypotension, hypertension (marked increase in systolic blood pressure indicates overdose), arrhythmias, dyspnoea, headache, fever.
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.
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