Monitor BP, heart rate, ECG, pulmonary capillary wedge pressure (PCWP), cardiac output, CVP, and urinary output continuously during the administration. Report significant changes in vital signs or arrhythmias. Consult physician for parameters for pulse, BP, or ECG changes for adjusting dose or discontinuing medication.
Palpate peripheral pulses and assess appearance of extremities routinely during dobutamine administration. Notify health care professional if quality of pulse deteriorates or if extremities become cold or mottled.
Lab Test Considerations:
Monitor potassium concentrations during therapy; may cause hypokalemia.
Monitor electrolytes, BUN, creatinine, and prothrombin time weekly during prolonged therapy.
Toxicity Overdose:
If overdose occurs, reduction or discontinuation of therapy is the only treatment necessary because of the short duration of dobutamine.
High Alert: IV vasoactive medications are potentially dangerous. Have second practitioner independently check original order, dose calculations, and infusion pump settings. Do not confuse dobutamine with dopamine. If available as floor stock, store in separate areas.
Correct hypovolemia with volume expanders before initiating dobutamine therapy.
Administer into a large vein and assess administration site frequently. Extravasation may cause pain and inflammation.
IV Administration
Continuous Infusion: Diluent: Vials must be diluted before use. Dilute 250–1000 mg in 250–500 mL of D5W, 0.9% NaCl, 0.45% NaCl, D5/0.45% NaCl, D5/0.9% NaCl, or LR. Admixed infusions stable for 48 hr at room temperature and 7 days if refrigerated. Premixed infusions are already diluted and ready to use. Concentration: 0.25–5 mg/mL.
Rate: Based on patient's weight (see Route/Dosage section). Administer via infusion pump to ensure precise amount delivered. Titrate to patient response (heart rate, presence of ectopic activity, BP, urine output, CVP, PCWP, cardiac index). Dose should be titrated so heart rate does not increase by >10% of baseline.
Y-Site Compatibility
alemtuzumab
alfentanil
alprostadil
amifostine
amikacin
aminocaproic acid
anidulafungin
argatroban
arsenic trioxide
ascorbic acid
atracurium
atropine
azithromycin
aztreonam
benztropine
bleomycin
bumetanide
buprenorphine
butorphanol
calcium chloride
calcium gluconate
cangrelor
carboplatin
caspofungin
chlorpromazine
ciprofloxacin
cisatracurium
cisplatin
cladribine
clindamycin
cyanocoblamin
cyclophosphamide
cyclosporine
cytarabine
dactinomycin
daptomycin
daunorubicin
dexmedetomidine
digoxin
diltiazem
diphenhydramine
docetaxel
dolasetron
dopamine
doxorubicin
doxorubicin liposome
doxycycline
enalaprilat
ephedrine
epinephrine
epirubicin
epoetin alfa
eptifibatide
erythromycin
esmolol
etoposide phosphate
famotidine
fenoldopam
fentanyl
fluconazole
fludarabine
fosfomycin
gemcitabine
gentamicin
glycopyrrolate
granisetron
hetastarch
hydromorphone
idarubicin
ifosfamide
irinotecan
isoproterenol
ketamine
labetalol
leucovorin calcium
levofloxacin
lidocaine
linezolid
lorazepam
magnesium sulfate
mannitol
meperidine
mesna
methyldopate
methylprednisolone sodium succinate
metoclopramide
metoprolol
milrinone
mitoxantrone
morphine
moxifloxacin
multivitamins
mycophenolate
nafcillin
nalbuphine
naloxone
nicardipine
nitroglycerin
norepinephrine
octreotide
ondansetron
oxaliplatin
oxytocin
paclitaxel
palonosetron
pamidronate
pancuronium
papaverine
pentamidine
phentolamine
phenylephrine
posaconazole
potassium acetate
potassium chloride
procainamide
prochlorperazine
promethazine
propranolol
protamine
pyridoxime
remifentanil
rituximab
rocuronium
sodium acetate
streptokinase
succinylcholine
sufentanil
tacrolimus
televancin
theophylline
thiamine
thiotepa
tigecycline
tirofiban
tobramycin
tolazoline
topotecan
trastuzumab
vancomycin
vasopressin
vecuronium
verapamil
voriconazole
zidovudine
zoledronic acid
Y-Site Incompatibility
acyclovir
alteplase
aminophylline
amphotericin B deoxycholate
amphotericin B lipid complex
amphotericin B liposome
ampicillin
ampicillin/sulbactam
azathioprine
bivalirudin
carmustine
cefazolin
cefotaxime
cefotetan
cefoxitin
ceftriaxone
cefuroxime
chloramphenicol
dacarbazine
dantrolene
dexamethasone
dexrazoxane
diazoxide
ertapenem
fluorouracil
folic acid
foscarnet
fosphenytoin
ganciclovir
hydrocortisone sodium succinate
hydroxycobalamin
ibuprofen
indomethacin
ketorolac
methotrexate
micafungin
mitomycin
oxacillin
pantoprazole
pemetrexed
penicillin G
pentobarbital
phenobarbital
phenytoin
piperacillin/tazobactam
sodium bicarbonate
thiopental
trimethoprim/sulfamethoxazole
warfarin
Patient/Family Teaching
Explain to patient the dobutamine and the need for frequent monitoring.
Advise patient to inform nurse immediately if chest pain; dyspnea; or numbness, tingling, or burning of extremities occurs.
Instruct patient to notify nurse immediately of pain or discomfort at the site of administration.
Home Care Issues:
Instruct caregiver on proper care of IV equipment.
Instruct caregiver to report signs of worsening HF (shortness of breath, orthopnea, decreased exercise tolerance), abdominal pain, and nausea or vomiting to health care professional promptly.
Evaluation/Desired Outcomes
Increase in cardiac output.
Improved hemodynamic parameters.
Increased urine output.
DOBUTamine is a sample topic from the Davis's Drug Guide.
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