There’s a national IV shortage that could affect you, too
Key Takeaways
North Carolina-based Baxter International—which makes 60% of intravenous (IV) and other medical fluids—was impacted by Hurricane Helene, causing a disruption in hospitals receiving the fluids they need. Several hospitals have put off certain electric and semi-elective procedures as a result.
The FDA says Dextrose 70% IV solution, Lactated Ringers IV Solution, and Peritoneal Dialysis Solution are now in inadequate supply. A blood shortage is also in effect, reports the Red Cross.
Experts say healthcare workers need to focus on smart, evidence-based conservation strategies for both IV fluids and blood.
After Hurricane Helene wreaked havoc on areas from Florida to the Southern Appalachians, certain hospitals have had to pause both elective and semi-elective surgeries due to a lack of necessary intravenous fluids.[] The hurricane affected North Carolina’s Baxter International, Inc., which manufactures 60% of IV and other medical fluids for hospitals, was affected by the hurricane.
As of last week, the U.S. Food and Drug Administration (FDA) issued temporary guidance on compounding certain parenteral drug products as a result of Hurricane Helene. Further, they say that they now consider Dextrose 70% IV solution, Lactated Ringers IV Solution, and Peritoneal Dialysis Solution “to not be commercially available in adequate supply to meet national demand.”[]
These shortages have a widespread impact: The University of Rochester Medical Center (URMC), for example, had to reschedule surgeries due to not receiving enough shipments of IV fluids. As of today, some of the surgeries have resumed.[] The problem is complex, Michael Apostolakos, MD, the chief medical officer at URMC told News10: “A lot of us manufacturers have facilities in other countries that the FDA has allowed them to import from, but there are logistics issues in getting that fluid here. There are labeling issues [when] getting it in, [labels written in English], the labels of the bags, and we anticipate it’s going to take several weeks.”
Cooley Dickinson Hospital and other Mass General Brigham system facilities will be postponing certain surgeries until Wednesday, October 16, as well. They’re not alone. Other hospitals putting procedures on hold include the UVA Health University Medical Center in Charlottesville, Virginia, and Enloe Health in Chico, California.[]
The complexity of the issue
According to Jared L. Ross, MD, an emergency physician and assistant professor at the University of Missouri, the problem isn’t as cut and dry as it seems: “This shortage has been significantly exacerbated by hoarding and panic purchasing by healthcare organizations after Hurricane Helene.” But there are ways to manage, he says: “With smart decisions by healthcare providers, this shortage does not have to negatively impact patient care, and may actually improve care, decrease cost, and encourage patients to eat and drink sooner, which will allow them to be discharged home sooner.”
He says that there are a few things clinicians should keep in mind in order to avoid excessive use of IV fluids: “Avoid IV fluids in patients with good oral intake or those undergoing minor procedures like colonoscopies, endoscopies, biopsies. Avoid IV fluids given for dubious reasons or placebo effects such as at IV spas or IV bars. And limit the use of IV Fluids in the ER—especially in patients with alcohol intoxication, as it does not improve outcomes nor reduce hospital length of stay,” he says.
Dr. Ross urges clinicians to use oral medications over IV when the patients can tolerate oral medications—noting that medications like corticosteroids and certain antibiotics (macrolides and fluoroquinolones) have the same absorption when given either orally or through an IV. “Saving sterile irrigation fluids for the operating room and using tap water for wounds in the emergency department [is key],” he says. “Tap water has actually been shown to be superior due to the higher pressure and higher volume used when compared to sterile saline.”
Conservative use should be the goal, Dr. Ross says. “If healthcare providers conserve IV fluids, there will be plenty of supply for those patients who really need it, such as ICU patients and those undergoing extended surgical procedures.”
It’s not just IV fluids. The American Red Cross is aiming to restock “critically needed blood products” which went uncollected due to the impact of the hurricane.[]
What about blood transfusions?
Sherri Ozawa, MSN, RN, patient blood management director at Accumen, says that blood meant for transfusion is a perishable item—one that requires careful tracking and logistical handling to protect patient safety.
“With hospitals already under heightened levels of stress as they try to keep patients out of harm's way, while dealing with a potential influx of injured patients and staffing hardships, blood, already in short supply, often is unavailable for patients,” she says. But it’s not just about attaining the blood—the focus should be on using it appropriately as well.
“Data tells us that blood transfusion can often be avoided by making every effort to ensure patients are optimally producing their own blood, proactively dealing with bleeding or patients at risk, and conserving a patient's own blood,” she says. “The best blood is the blood in our own bodies, it is our job as healthcare providers to keep it there and keep it healthy."