Background

In late September, 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 were told to expect only 40% of their normal shipments.

In response to the shortages, hospitals began conserving fluids, with some switching to giving patients Gatorade or water instead of an IV. Some hospitals have also postponed elective outpatient and inpatient surgeries so IV fluids could be prioritized for critically ill patients.

In October, the Biden administration invoked the Defense Production Act to help Baxter speed up the rebuilding of its North Carolina manufacturing facility. FDA also authorized the company to temporarily import fluids from its facilities in other countries, including the United Kingdom, Ireland, China, and Canada.

In an update posted Nov. 7, Baxter said that its North Carolina facility had resumed producing some IV fluid and that customers would be able to order normal quantities of "certain IV fluid solutions products" by the end of the year. However, there is currently no timeline for when the facility will be back to its pre-hurricane production levels.

How hospitals are managing amid the IV fluid shortage

After several weeks of conservation, hospitals in certain areas have reported that their supplies of IV fluids have begun to stabilize.

"The supply disruption is beginning to end," said Patrick Allen, from the New Mexico Department of Health. "We've been able to move supply around. Baxter has gotten most of its lines back up and running. The things that are in particularly short supplies, there’s irrigation saline, that's used for procedures that do a lot of washing things out while they’re doing procedures, so, think, like, knee and hip replacements."

However, Sam Elgawly, chief of resource stewardship at Inova, said he expects to be managing a shortage of IV fluids for some time and is looking for different ways to conserve supply.

"We are going to operate under the assumption that this is going to be the way it is through the end of 2024 and have adopted our demand/conservation measures accordingly," Elgawly said.

One way hospitals are trying to conserve IV fluids is to give some medications intravenously, but without a dedicated IV fluid bag, which is known as a push medication. "You don't even need a bag at all. You just give the medication without the bag," Elgawly said. "There has been increasing literature over the last 10 to 20 years that indicates maybe you don't need to use as much. And this accelerated our sort of innovation and testing of that idea."  

Monica Coleman, a nurse at a Department of Veterans Affairs hospital in North Chicago, said push medications can be more time-consuming for nurses since they need to monitor the patients during the administration process. "This could increase adverse effects within the patient, because we're giving the medication at a faster rate," she said.

Another conservation method that Elgawly is interested in testing is retooling EHRs to question whether doctor orders for more IV hydration is necessary.

"Does the patient actually need that second bag? How did they do today with eating or drinking water or juice? They did well? They don't need the bag," Elgawly said. "So it's little conservation mechanisms like that that, when you add them across, you know, the 2,000-patient system that Inova is, make a significant dent."

In addition, Vince Green, CMO at Pipeline Health, said he has directed hospital staff to use up an entire IV bag before starting another one. "If they come in with IV fluids that the paramedics have started, let's continue it. If it saves half a bag of fluids, so be it, but it adds up over time," he said.

According to Green, simpler conservation methods could become more common after the IV fluid shortage ends, though he would like to see data showing that patient outcomes aren't affected first. "From an environmental aspect, we don't need to have this much waste and fill up our landfills. If we could reduce stuff, I think it'd be wise," he said.

Still, Green said he would feel better when his hospital could receive a full order of IV fluid, which could still be weeks away. Currently, the hospital is down to a two-week supply, with an expected increase in hospitalizations due to the respiratory virus season.

"We're purchasing every IV fluid bag that we can get," Green said. (Fortiér, KFF Health News, 11/19; Olague, KRQE, 11/18) 

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