Background and importance Congestive heart failure (CHF) management in outpatients is often complicated. Increasing oral diuretics or combining drugs to improve a patient’s symptoms is not always effective enough. To avoid hospital admissions, furosemide subcutaneus administration has been proposed as a useful alternative. Comparing intravenous with subcutaneous infusion of furosemide, the latter is supposed to increase diuresis using lower furosemide doses, reduce hospital stays and minimise re-entry rates.
Aim and objectives Our aim was to describe furosemide subcutaneous infusion by portable pump (FPP) use in a tertiary hospital.
Material and methods Retrospective study in which all outpatients treated in 2020 and 2021 with FPP, monitored by the cardiology unit, were included. Pumps which provided an infusion flow rate of 0.5 mL/hour were used. Length of infusion was 7 days/pump. The formulation’s pH was 8.7. Once prepared, FPP could be stored for 84 days at room temperature or in a refrigerator and protected from light. Demographic data, diagnosis and clinical results were collected. Efficacy was measured by the N-terminal pro B-type natriuretic peptide (NT-proBNP), body weight and plasma sodium descent. Security was measured by changes in glomerular filtering (GF).
Results 46 FPP were prepared for 31 patients (19 males, 12 females; medium age 69 (30–90) years). 7/31 received two, 1/31 three and 3/31 four cycles of FPP. Medium length of treatment was 10 (5–28) days. 30/31 received 120 mg/day furosemide (final concentration 10 mg/mL) per pump and 1/31 80 mg/day furosemide with serum saline (6.6 mg/mL) per pump. Pumps were prescribed for descompensated CHF (31/31), 2 of them after heart transplantation and 1 due to transthyretin amyloidosis.
Mean weight loss was 2.6±2.9 kg. NT-proBNP was reduced in 12/31 patients, and unknown in 6/31 patients. Mean NT-proBNP reduction was 280.81 pg/mL. Plasma sodium decreased in 12 patients and the average reduction was 0.85±6 mEq/L.
There was worsening GF in 18/31 patients (medium change in GF was –6.50 mL/min). No patient experienced local infection, rash irritation or flow problems with administration.
Conclusion and relevance FPP allowed patients to improve some CHF measures outside the hospital. Our study supports the use of FPP, being safe and effective.
Pharmacists have a key role by checking the dose, ensuring physical–chemical stability and sterile conditions in preparation, and instructing patients in the use of FPP.
Conflict of interest No conflict of interest
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