Managing an Advanced Heart Failure Patient at Home With a Long-Term Continuous Intravenous Furosemide Infusion

Objective: To describe a simple therapeutic intervention for persistent congestion in an advanced heart failure patient using a continuous intravenous furosemide infusion in the home setting with a non-powered elastomeric pump that can be managed by the patient.

Key steps: Patient selected as a known intravenous furosemide responder with a supportive home environment. Shared care decision making with patient, cardiologist, heart failure nurse practitioner, palliative care physician, and general practitioner. Initiate this method of furosemide administration as an inpatient to test feasibility and determine choice of intravenous access. Communication links among lead prescriber, patient, hospital pharmacy, community nursing coordinator, patient's primary care practitioners. Community intravenous nursing support to initially change pumps, maintain intravenous line and site dressing, blood draw, teach patient to self-manage the prefilled pump changes. Baxter for compounding prefilled pumps.

Potential pitfalls: Permanent intravenous lines carry the risk of thrombosis, migration, and infection. High dose furosemide may cause ototoxicity, renal injury, electrolyte disturbance and hypotension.

Take-home messages: Persistent congestion from chronic heart failure can be safely managed in the home with a continuous high dose intravenous furosemide infusion. In our experience, the use of elastomeric pumps has provided a simple, safe, and effective method of delivering intravenous diuretic therapy when coordinated by heart failure nurses.