Monitor BP, HR, ECG, pulmonary capillary wedge pressure (PCWP), cardiac output, central venous pressure (CVP), and urinary output continuously during the administration. Report significant changes in vital signs or arrhythmias. Consult physician for parameters for HR, 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 during therapy; may cause hypokalemia.
Monitor electrolytes, BUN, and serum creatinine weekly during prolonged therapy.
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.
Continuous Infusion: Dilution: 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, LR, or D5/LR. Admixed infusions stable for 24 hr at room temperature and 48 hr if refrigerated. Premixed infusions are already diluted and ready to use. A pink color may occur due to oxidation of the drug; there is no significant loss of potency over 24 hr. 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 (HR, presence of ectopic activity, BP, urine output, CVP, PCWP, cardiac index). Dose should be titrated so HR does not increase by >10% of baseline.
Explain the purpose and side effects of 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 IV administration.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Home Care Issues:
Instruct caregiver on proper care of IV equipment.
Instruct caregiver to report signs of worsening HF (shortness of breath, orthopnea, ↓ exercise tolerance), abdominal pain, and nausea or vomiting to health care professional promptly.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.