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December 18, 2024
Supply of IV Fluids: Year-End Status

Supply of IV Fluids: Year-End Status

As you will recall, Hurricane Helene did a real number on a large swath of the Southeast. Its path of destruction encompassed one of America’s primary producers of IV fluids used in hospitals across the country. The Baxter plant in North Carolina, where approximately 60 percent of the nation’s IV fluid supply is manufactured, was ravaged by unprecedented floods caused by Helene’s relentless rain. The plant was forced to shut down, beginning in late September. As a result, more than 86 percent of hospitals quickly began experiencing shortages of IV fluids. Shortages were evenly spread nationwide, across all provider types.

Supply of IV Fluids: Year-End Status

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The shortage of these vital fluids was expected to last through the end of the year. Well, we are nearing that point; so, now may be a good time to take stock of where we are with the nation’s IV fluid supply.

Plant Progress

According to a December 15 report from the Public Broadcasting System (PBS), the North Carolina Baxter factory is now making some IV fluid products, but the company hasn't announced a date when they expect to be back to pre-hurricane production levels. In the meantime, the IV fluid shortage is continuing. One healthcare journalist said he recently spoke with a hospital administrator in Los Angeles, who informed him that their facility is only getting 60 percent of their normal IV fluid order.

On checking Baxter’s website, a December 5 entry contained the following updates:

Led by Baxter’s commitment to product quality and patient safety, equipment repair and phased testing continues to progress across all production lines, which is, in coordination with FDA, supporting resumption of operations in phases. 

    • NEW: We are making continued strong progress at our North Cove site, including the initial resumption this week of the following: 
    • All 3L irrigation manufacturing lines 
    • All peritoneal dialysis (PD) solutions manufacturing lines  
    • Note that while production on these lines has restarted, it will take some time for the lines to ramp up and produce at pre-hurricane levels. 
    • Two IV solutions manufacturing lines that restarted in November produce ~85% of the site’s pre-hurricane capacity of 1-liter IV solutions, the most commonly used size by hospitals and clinics.  
    • Baxter released the first product – 1-liter IV solutions -- that was manufactured post-hurricane the week of Nov. 18.  
    • Initial batches were manufactured concurrently with ongoing quality activities and are only being released in accordance with applicable regulatory requirements to ensure the quality and safety of the products.  
    • All of the above milestones have been ahead of our original expectations and made possible by the dedication and resilience of the North Cove and broader Baxter teams, working in coordination with FDA. 
    • While we currently expect that all available lines will be restarted by the end of the year, we do not yet have a specific date for when we expect North Cove production to be fully restored to pre-hurricane levels. 

We’re glad to see there has been progress made by Baxter’s team to get back to pre-hurricane levels, but we’re still not there yet. So, what are hospitals to do in the meantime?

Plan B, C and D

According to the PBS report, hospitals are doing all they can to conserve IV fluids. One District of Columbia hospital administrator indicated the slashing of over half their IV fluid usage since the shortage began. Here are some ways they’re going about this:

    • Telling emergency room patients to drink Gatorade or Pedialyte instead of getting an IV.
    • Switching patients from liquid medications to pills sooner than they normally would.
    • Using up the entire IV bag before starting another.
    • Giving some medications intravenously but without a dedicated IV bag, which is known as a push medication.

According to KFF Health News, some hospital administrators see an opportunity in the IV fluid shortage to question standard practices. “There has been increasing literature over the last 10 to 20 years that indicates maybe you don’t need to use as much,” said Sam Elgawly, chief of resource stewardship at Inova, a health system in the D.C. area.“ He then said he’s keeping one question front of mind: “How often are we actually giving it more than we need to, where we just keep it going because a patient’s in the hospital?”

So, the upshot of all this is that hospitals are learning to make do and adapt out of necessity. Hopefully, the shortage of these critical supplies will abate in the next few weeks.