Prescribing information of nesiritide mandates priming
of intravenous tubing with 25 mL of nesiritide prior to
connecting the intravenous (IV) line to the patient, since
the drug may partially absorb to the line. Thus, 10% of
a reconstituted vial is wasted, with a cost of $40-50 per
line used. No study has quantified the binding effect of
nesiritide to intravenous tubing, tested binding
properties of different materials, or analyzed binding
effect of central lines, where priming cannot occur.
Furthermore, prescribing information states that
nesiritide must not be administered through a central
heparin-coated catheter, since it may bind to heparin.
However, no study quantified this binding effect.
1.5 mg vials of nesiritide were reconstituted into 250 mL
0.9% NS bags. A 23.3mL bolus, followed by 7mL/h 2-
hour infusion (2ug/kg bolus, 0.01ug/kg/min infusion for
a 70kg pt) were run, in duplicate, through 5 separate
experimental tubing systems: 1) Standard PVC
peripheral IV tubing primed with a 25 mL of nesiritide;
2) Standard non-primed PVC peripheral IV tubing; 3)
Non-primed polyethylene peripheral IV tubing,
commonly used for NTG infusion; 4) Non-primed PVC
peripheral IV tubing, connected distally to a central IV
polyurethane catheter; 5) Non-primed PVC peripheral
IV tubing, connected distally to a heparin-coated
pulmonary artery PVC catheter. Nesiritide concentration was measured,
in triplicate, in the initial bags and
samples collected from the five IV settings, using Biosite
BNP test (Beckman Coulter).
Presented at 2004 Heart Failure Society of America
– Eighth Annual Scientific Meeting
Onat PhD, Duygu; Stathopoulos MD, John; Rose MD, Andrew B.; Newman PhD, Karel; Jorde MD, Ulrich P.; and Colombo MD, Paolo C.
"The Use of Non-Primed Peripheral and Central IV Tubing for Nesiritide Infusion is Reliable and Cost-Effective,"
The Medicine Forum:
Vol. 6, Article 19.
Available at: http://jdc.jefferson.edu/tmf/vol6/iss1/19