Navigating the IV Fluid Shortage

With the shortage continuing to be an issue and affecting healthcare providers across the country, various protocols and strategies have been implemented to mitigate the impact. This blog post will explore the root causes of the IV fluid shortage, the specific products affected, the protocols in place to manage the situation, and the plans to increase supply in the coming months.

The Beginning: Hurricane Helene's Impact on IV Fluid Manufacturing

Hurricane Helene, a Category 4 storm, made landfall in the Big Bend region near Perry, Florida, with winds reaching 140 mph. It was the first Category 4 storm to hit this area since records began in 1851. After striking Florida, Helene roared through Georgia as a powerful tropical storm, leaving destruction in its wake. As the storm tracked inland, it ultimately reached the foothills of North Carolina, where it severely disrupted operations at Baxter International's North Cove production sitethe largest manufacturer of IV fluids and dialysis solutions in the U.S.

Located in Marion, North Carolina, Baxters North Cove facility is critical in producing medical supplies used nationwide. Despite its inland location, the storm caused significant flooding to the building, which forced the plant to halt production. This disruption quickly rippled across the healthcare system, causing an acute shortage of essential IV fluids used in everyday patient care, surgeries, and emergency treatments.

What's Included in the Shortage?

As a result of the hurricane, the shortage encompasses several essential products crucial for patient care. According to the FDA, the products impacted include:

• Sodium Chloride (saline): Used in hydration and as a vehicle for drug administration, saline is a staple in most medical treatments.
• Dextrose solutions: These fluids are vital for patients requiring glucose, particularly in emergencies or when oral intake is not possible.
• Lactated Ringers: Commonly used in trauma and surgical settings, this solution helps balance electrolytes and fluids in patients.
• Peritoneal Dialysis solutions: Critical for kidney failure patients undergoing dialysis, the shortage of these fluids presents significant challenges.

In response to the supply chain disruption, the FDA has allowed the temporary importation of IV fluids from foreign manufacturers and issued guidance on the compounding of certain IV drugs to ease the strain. However, full recovery from the disruption will take time, leaving healthcare providers in a delicate balance of managing conservation strategies while awaiting a return to normal supply levels.

Protocols and Conservation Strategies to Mitigate the Shortage

As the IV fluid shortage continues to impact healthcare systems across the country, hospitals are following national protocols to conserve resources while ensuring patient care is not compromised. The American Society of Health-System Pharmacists (ASHP) and ASPR TRACIE have outlined several conservation strategies that are now widely implemented.

One key protocol is to prioritize the use of IV fluids for critically ill patients, such as those in intensive care or undergoing emergency surgeries. Hospitals are shifting to oral rehydration methods or subcutaneous fluids (hypodermoclysis) for patients who can tolerate alternative treatments. In addition, non-emergency surgeries and procedures that require IV fluids are being delayed or rescheduled to preserve these essential resources for critical cases.

Conservation of IV Fluids:

• Smaller Volume Bags: Many hospitals are opting for smaller volume IV fluid bags, when possible, to stretch existing supplies.
• Pre- and Post-Surgical Adjustments: Hospitals are reducing the use of IV fluids in less urgent situations, such as routine hydration before and after surgeries. Adjusting pre- and post-operative protocols allows healthcare providers to save IV fluids for more critical care settings.
• Shifting to Oral Medications: In cases where IV medications are not essential, oral alternatives are prescribed. This applies particularly to post-operative care or patients with less acute conditions.
• Centralized Inventory Control: Healthcare systems are centralizing their stock of IV fluids to ensure they are distributed efficiently across departments, reducing waste and optimizing usage.

The collaboration between hospital leadership, pharmacy teams, and healthcare coalitions ensures that resources are allocated appropriately and critical needs are met. These measures are not just a short-term fix; they are part of a broader strategy to cope with ongoing supply chain disruptions and potential future shortages.

Communication between healthcare coalitions and supply chain managers is essential during the shortage. Hospitals are encouraged to communicate frequently with suppliers to ensure an accurate understanding of current inventory levels and delivery timelines. Regular stock level monitoring allows for real-time adjustments, helping avoid unexpected shortages in high-demand areas.

The current protocols and conservation strategies allow hospitals to maintain patient safety while stretching limited supplies of IV fluids. However, these measures will need to remain in effect until production at Baxters North Cove facility fully resumes and the supply chain stabilizes.

Plans to Increase Supply

Efforts to alleviate the IV fluid shortage caused by Hurricane Helene are well underway, but recovery will take time. Baxter International has begun increasing allocations of IV fluids and expects to reach 90% to 100% of normal supply levels by the end of the year. Baxter is scaling up production at global facilities to meet short-term demands while other domestic manufacturers step in to fill gaps. The FDA is working with Baxter to expedite shipments and has approved temporary imports of IV fluids from international sources. Allocations for critical care facilities, especially children's hospitals, have been prioritized, with some reaching 100% supply.

Hospitals are urged to continue implementing conservation strategies until supplies stabilize. This includes prioritizing IV fluids for critical patients and substituting with oral or subcutaneous fluids when appropriate.

The IV fluid shortage caused by Hurricane Helene has significantly impacted patient care across the United States, underscoring the vulnerability of healthcare supply chains to natural disasters. Despite ongoing efforts to restore production and increase supply, the shortage is expected to persist for some time. In response, hospitals have been implementing various conservation strategies and protocols to mitigate the impact on patient care. As production continues to ramp up and alternative sources come online, the healthcare industry will remain focused on navigating this challenge to ensure that patients receive the care they need during this critical time. Patients, providers, and regulatory bodies must work together collaboratively to effectively manage the current shortage while laying the groundwork for a more resilient future in healthcare supply chain management.