title: Interaction between nesiritide and a heparin-coated pulmonary artery line during an infusion for decompensated heart failure.
abstract: 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.
authors.affiliation: Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA 02115, USA. sbaroletti@partners.org
authors.forename: Steven A
authors.initials: SA
authors.lastname: Baroletti
authors.forename: Heather D
authors.initials: HD
authors.lastname: Wahlstrom
mesh_terms: 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*
chemical_list: D000925:Anticoagulants; D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain; D006493:Heparin