Interaction between nesiritide and a heparin-coated pulmonary artery line during an infusion for decompensated heart failure.
OBJECTIVE
Because it is known that intravenous nesiritide is not compatible with unfractionated heparin, we sought to determine the effect that heparin coating on a pulmonary artery catheter may have on the efficacy of a nesiritide infusion.


METHODS
The efficacy of a nesiritide infusion given through a heparin-coated pulmonary artery line was compared with that of a nesiritide infusion administered in the same patient through a heparin-free peripheral line.


RESULTS
The rate of infusion was titrated to maintain consistent hemodynamic parameters. When nesiritide was administered through a heparin-coated line, the infusion rate escalated from 0.01 microg/kg/minute to 0.07 microg/kg/minute. After the route of administration was switched to a heparin-free line, the same hemodynamic parameters were maintained. The heparin-free line made it possible to reduce the infusion rate by 57.1% over the next 24 hours to 0.03 microg/kg/minute.


CONCLUSIONS
The interaction of nesiritide with heparin-coated pulmonary artery lines has the potential to be clinically significant. Clinicians should be educated about this potential interaction. Nesiritide should be infused only through heparin-free lines.
Baroletti
Steven A
SA
Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA 02115, USA. sbaroletti@partners.org
Wahlstrom
Heather D
HD
D000368:Aged; D000925:Anticoagulants; D004347:Drug Interactions; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006493:Heparin; D006801:Humans; D007261:Infusions, Intra-Arterial; D045283:Natriuretic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage / Q000627:therapeutic use*
D000925:Anticoagulants; D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain; D006493:Heparin