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