Authors

Cristina M. Riveiro-Rodríguez1, David Couto-Mallón2, Carmen Naya-Leira1, María Jesús Paniagua-Martín2,   Eduardo Barge-Caballero2,4, Gonzalo Barge-Caballero2, Marta Sagastagoitia-Fornie2, María José Mauriz -Montero3, José Manuel Vázquez-Rodríguez2,4, María G. Crespo Leiro2,4.

Position

1 Enfermera Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Hospital Universitario A Coruña.   2 Cardiólogo Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Servicio de Cardiología, Instituto de   Investigación Biomédica de A Coruña (INIBIC), Hospital Universitario A Coruña.  3 Farmacéutica Servicio de Farmacia, Hospital Universitario A Coruña.  4 Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid.

Contact address

Cristina M. Riveiro-Rodríguez. Unidad de IC y trasplante cardiaco. Hospital Universitario A Coruña. Xubias de Arriba 84. 15006 A Coruña

Abstract

Introduction. A frequent cause of hospitalization in patients with heart failure is congestion refractory to oral diuretics and is treated with intravenous furosemide. Subcutaneous furosemide administration may be an alternative. Objective: To analyse our initial experience with the use of subcutaneous furosemide administration by elastomeric infuser for 7 days.
Material and methods. Retrospective single-centre study. Inclusion criteria: 1) Refractory congestion without low output; and 2) informed consent. The indication is made by the cardiologist. Fixed dose subcutaneous furosemide (120 mg/day) was administered; the infuser was prepared by hospital pharmacy and the implantation, follow-up and specific education was carried out by the nurse. The patient controls daily diuresis, as well as routine self-control of HF. Every 48 hours, analytical and telematic control was performed. The quantitative variables were analysed using the Wilcoxon test.
Results. Since April 2020, 20 treatments were performed in 15 patients. Three patients required >1 treatment. Median treatment time was: 7 days (IQR 5-13). There was a significant weight reduction (median weight loss 2.9 kg, IQR 0.45–4.45, p=0.002), without renal deterioration (basal median Cr 1.46 vs. final Cr 1.58 mg/dL; p=0.233) or hypokalaemia (basal median K+ 4.3 vs. final K+ 4 mEq/L; p=0.640). After a median follow-up of 171 days, 73% of patients remained free of admission, three patients died, one was transplanted, and two had mild adverse effects.
Conclusion. In this preliminary experience, subcutaneous furosemide administration by elastomeric infuser for 7 days achieved clinical and weight improvement in advanced heart failure patients with refractory congestion, safely avoiding hospitalizations in >70% of episodes.

Keywords:

heart failure; diuretics; furosemide; infusion pump; subcutaneous infusion

Versión en Español

Título:

Furosemida subcutánea mediante infusor elastomérico en pacientes ambulatorios con insuficiencia cardiaca. Experiencia inicial

Bibliography