Interaction between nesiritide and a heparin-coated pulmonary artery line during an infusion for decompensated heart failure.

Study 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.

Conclusion: 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.