Reliability of nesiritide infusion via non-primed tubing and heparin-coated catheters

BACKGROUND: Prescribing information for nesiritide mandates priming of intravenous tubing prior to connecting to the patient's intravenous access because the drug may adsorb to the line. As of this writing, no published study has quantified the binding effect of nesiritide to intravenous tubing. OBJECTIVE: To investigate whether priming of peripheral intravenous tubing is necessary and whether nesiritide can be reliably delivered through central intravenous lines, including heparin-coated catheters, where priming cannot occur. METHODS: A 23.3-mL bolus of nesiritide followed by a 7-mL/h 2-hour infusion were run through (1) Polyvinylchloride (PVC) peripheral intravenous tubing primed with nesiritide, (2) non-primed PVC peripheral intravenous tubing, (3) non-primed polyethylene peripheral intravenous tubing, (4) non-primed PVC peripheral intravenous tubing connected to a central intravenous polyurethane catheter, and (5) non-primed PVC peripheral intravenous tubing connected to a heparin-coated pulmonary artery PVC catheter. Nesiritide concentrations were measured in the intravenous bags and in samples collected from the 5 intravenous settings. RESULTS: Priming of intravenous tubing with nesiritide did not increase drug recovery: at least 94% of the bolus dose and 96% of the total drug were recovered from all intravenous sets. CONCLUSIONS: Infusion of nesiritide via non-primed peripheral and central intravenous tubing, including heparin-coated pulmonary catheter, is reliable. Changes in nesiritide labeling appear to be warranted.