Background Subcutaneous furosemide (SCF) usage is infrequent, and often found in geographical pockets. Fluid overload requiring diuresis occurs in a number of disease processes including heart failure, malignancy and liver disease. It carries a significant symptom burden and has historically required multiple inpatient admissions for parenteral diuretic administration. SCF infusion shows complete bioavailability (99.65%) and equivalent diuresis when compared with intravenous furosemide, and can provide significant symptom relief, prevention of hospital admission and associated patient satisfaction.¹

Aim To demonstrate the beneficial usage of SCF in a variety of settings, disease pathologies and disease stages.

Method A retrospective qualitative and quantitative case series was collected, using an online survey tool, from a network of clinicians working with palliative patients across the West Midlands. Participants submitted anonymous details of cases where SCF had been considered or utilised. We then assessed for common themes.

Results 26 cases were reported, from hospices, hospitals and community settings, with a range of disease pathologies. The data collected demonstrated the effectiveness of SCF via CSCI for symptom control in 70% cases, allowing patients to remain in or return to their preferred place of care in 57% of cases, and enabling a comfortable death in 39%. SCF was also effective when used in a single patient over two years. Forms of monitoring varied according to individual patient factors. Problems encountered were primarily around lack of confidence of clinical teams, although a few described supply issues or site reactions.

Conclusion

• SCF is successfully being used for the relief of heart failure symptoms across settings

• If utilised more, SCF could help patients remain in their preferred place of care for longer, reduce hospital inpatient stays and reduce the risks and distress associated with intravenous cannulation

• Increasing research and education around SCF may improve the confidence of clinical teams

Reference

1. Sica DA, Muntendam P, Myers RL, Ter Maaten JM, Sale ME, de Boer RA, Pitt B. Subcutaneous Furosemide in Heart Failure: Pharmacokinetic Characteristics of a Newly Buffered Solution. JACC Basic Transl Sci. 2018 Feb 7;3(1):25–34.