Hospitals around the country are conserving intravenous fluid supplies to cope with a shortage that could last months. Some hospital administrators say they are changing how they think about IV fluid hydration altogether.
Hurricane Helene, which hit North Carolina in September, wrecked a Baxter International facility that produces 60% of the IV fluids used in the United States, according to the American Hospital Association.
The Deerfield-based company was forced to stop production and is rationing its products.
Baxter says its North Cove, N.C., facility has resumed producing some IV fluids and that normal quantities of “certain IV solutions products” will be available by the end of the year, but there is no timeline for when the North Cove facility will be back to prehurricane production levels.
Meanwhile, hospitals are facing seasonal strains on their already-limited IV fluid resources.
“We’ve been very aggressive in our conservation measures,” says Sam Elgawly, chief of resource stewardship for Inova, a health system in the Washington, D.C., area, who says its IV fluid usage has dropped 55% since early October but that patient care hasn’t been compromised.
“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 says.
At the end of a calendar year, many people with insurance typically hurry to schedule surgical procedures before their deductibles reset in January.
With an eye to that rush and the impending peak of respiratory virus season, Elgawly says there’s been an effort to stockpile IV fluid bags. Also, hospitals are conserving by, for instance, giving some medications intravenously but without an IV fluid bag, known as a push medication.
“You just give the medication without the bag,” he says.
Monica Coleman, a nurse at the federal Department of Veterans Affairs hospital in North Chicago, says using push medications takes more of nurses’ time because they need to monitor the patients getting them.
But, Coleman says, “This could increase adverse effects within the patient because we’re giving the medication at a faster rate.”
Elgawly is interested in retooling electronic health records to question doctor orders for more IV hydration.
“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. 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,” he says.
Simpler conservation measures could become common after the shortage abates, says Vince Green, chief medical officer for Pipeline Health, a small hospital system in the Los Angeles area that mainly serves people on Medicare and Medicaid. But first Green says he’d want to see data showing that patient outcomes aren’t affected. For now, he has directed hospital staffers to use an entire IV bag before starting another.
“If they come in with IV fluids that the paramedics have started, let’s continue it,” Green says. “If it saves half a bag of fluids, so be it, but it adds up over time.”
Also, he says, patients might be asked to take more accountability for their hydration, for instance by drinking Gatorade or water rather than the default of hydrating through an IV.
But he’ll feel better when his hospitals receive a full order, which could be weeks away. Green says they are down to a two-week supply as an increase in hospitalizations due to respiratory virus season is expected.
“We’re purchasing every IV fluid bag that we can get,” he says.
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