How an IV fluid shortage is impacting healthcare

Earlier this month, Hurricane Helene caused severe damage across several states, including Florida, South Carolina, North Carolina, Georgia, Tennessee, and Virginia. One of Baxter International's IV fluid manufacturing facilities in Marion, North Carolina, was also damaged in the storm, leading to a temporary closure.

Baxter's North Carolina facility supplied around 60% of the IV solution used by U.S. hospitals every day. According to Nancy Foster, VP of quality and patient safety policy at the American Hospital Association (AHA), hospitals nationwide that rely on Baxter have been told to expect only 40% of their normal shipments.

"And that's all that will be available to them until the situation begins to improve," Foster said.

In a survey from Premier, 86% of healthcare providers reported experiencing shortages of IV fluids, and smaller providers were the most likely to not receive ordered IV solutions. At the time, roughly half of providers said they had 10 days or fewer of fluid supplies, down from an average of 15 to 22 days of supplies.

In response to the shortages, hospitals have started conserving fluids, and some have switched to giving patients Gatorade or water instead of an IV. Some hospitals have also started postponing elective outpatient and inpatient surgeries so IV fluids can be prioritized for critically ill patients. The shortages are expected to impact surgeries for several weeks.

This delay in elective surgeries may also negatively impact hospitals' finances. According to AHA data, hospitals experienced a net operating loss of more than $200 billion over a four-month period during pandemic lockdown in 2020 — which was due in part to cancelled or delayed care.

Current efforts to improve supplies

Currently, Baxter said it is aiming to restart production at its North Carolina facility in phases and "return to 90% to 100% allocation of certain IV solution product codes by the end of 2024."

In the meantime, FDA has authorized the company to temporarily import fluids from its facilities in other countries, including the United Kingdom, Ireland, China, and Canada. The agency has also issued temporary guidelines to make it easier for compounding pharmacies to produce certain IV fluids that are currently in short supply.

Last week, the Biden administration invoked the Defense Production Act to help speed up the rebuilding of Baxter's North Carolina facility. This allows the company to obtain materials to clean and rebuild the facility.

"Ensuring people have medical supplies they need is a top priority of the Administration," said an HHS official. "It's exactly why we are working closely with Baxter to support cleanup and restoration of the facility, including invoking the Defense Production Act to help production resume as quickly as possible." 

B. Braun Medical, another major IV solution manufacturer, has also increased production of IV fluids at its Florida and California facilities to help meet hospitals' supply needs.  

Aside from these short-term solutions, health experts have also called for longer-term solutions to prevent IV fluid shortages from occurring in the first place.

Writing for MedPage Today, Robert Glatter, an assistant professor of emergency medicine at the Zucker School of Medicine at Hoftstra/Northwell, Lenox Hill Hospital, and Northwell Health, as well as Peter Papadakos, director of critical care medicine and a professor of anesthesiology, surgery, neurology, and neurosurgery at the University of Rochester, said there needs to be federal regulations that require production facilities to be distributed more evenly throughout the United States.

"Stakeholders must reconsider geographical distribution of production facilities, and not rely on a single facility to produce the majority of IV fluids," they wrote.

Glatter and Papadakos also noted that organizations need to account for climate change when it comes to their production processes and supplies. Factoring in potential risks of flooding and wind damage could help companies, as well as federal agencies, develop strategies to ensure the safe production of IV fluids and other essential medical resources.

"The fragile ecosystem and supply chain in our nation's healthcare industry remains vulnerable unless we design and implement practical solutions that focus on regionalization and diversification of U.S. production facilities," Glatter and Papadakos wrote. (Murphy, Associated Press, 10/22; Glatter/Papadakos, MedPage Today, 10/23)

Explore our toolkit with insight on the future healthcare supply chain, including case studies from high-performing providers and suppliers.