Hurricane-induced IV fluid shortages prompt hospitals to postpone surgeries

Compounding facilities that do not typically manufacture IV fluids need access to supplies such as sterile water and bags to make their own product. The American Hospital Association estimates that less than one-fifth of hospitals are able to do this.

“If you cut off the hospital's IV fluid supply, it's like turning off the water supply to your home,” said Chris DiRienzo, chief medical executive of the hospital association. “We need to have a steady, consistent flow to the hospital, especially as we head into the winter respiratory virus season.”

More than 86 percent of health-care providers nationwide are experiencing an IV fluid shortage after Hurricane Helen, according to a survey of more than 250 providers released Thursday by Premier, a health-care technology and supply chain company.

About 17 percent of respondents have ruled out elective surgery, and another 58 percent are considering doing so in the near term.

The shortage was caused by flooding at Baxter International's North Cove manufacturing site caused by Hurricane Helen's unprecedented rain and storm surge in western North Carolina. These fluids are used to keep sick people hydrated, for dialysis patients, and for surgery, among other purposes. Baxter supplies 60 percent of the IV fluids used in the United States.

Baxter, in a statement Monday, said 3,000 people will be working on recovery operations at the plant this week. The company said its goal is to phase in and resume operations Return to 90 to 100 percent allocation of some products by the end of the year.

A temporary bridge built in the area helped transport 350 trucks of goods, the agency said, and another bridge is being installed.

The company said The agency is working with the FDA to approve imports from other Baxter manufacturing sites overseas after last week approving temporary shipments from five facilities in Canada, China, Ireland and Britain. The primary sources of additional supplies of IV fluids will be large manufacturing sites overseas, according to a senior administration official on Monday who spoke on condition of anonymity because he was not authorized to speak publicly. The Department of Health and Human Services said it is supporting efforts to airlift IV fluids into the country as soon as possible.

Michael Felberbaum, an FDA spokesman, said the agency has taken several steps to help address the shortage as quickly as possible, such as working with manufacturers to increase supplies and issuing guidelines for compounding pharmacies to help fill gaps.

For more than two weeks, hospitals and health systems have been implementing protocols in an effort to conserve the nation's IV fluid supply. These include keeping partially used IV fluid bags when they are discarded instead of transporting the patient to the hospital; transitioning to oral hydration for some patients, including water, Gatorade, or Pedialyte; And it is medically necessary to assess patients to confirm an IV before hanging the bag.

Duke University Hospital has been scrutinizing every use of IV fluids since the hurricane hit Continue to do so in the coming weeks.

“It's a commonly available fluid that healthcare probably takes for granted,” said Jonathan Bay, the hospital's chief quality officer.

Not all hospitals are drastically affecting their supply. But the Premier is recommending that they all take steps to help conserve produce.

“It's very similar to the messaging we used during the pandemic where regardless of whether you were in a hot spot or not, you need to conserve available supplies to do what's in the national best interest,” said Premier's Soumi Saha, senior vice president of government affairs.

Northwell Health, New York's largest health system, said in a statement that it receives IV solutions from a different manufacturing facility but is reviewing all fluid orders during patient rounds and is now turning to alternative manufacturers to help conserve supplies for other hospitals.

Mass General Brigham, Massachusetts' largest health system, is delaying some elective procedures that rely on IV fluids until at least Wednesday.

Deficiency also affects irrigation fluid, which goes into cavities such as joints and bladder during operations to prevent infection.

Reed Adams, chief medical officer at the University of Virginia Health University Medical Center, said the hospital is operating mostly as normal but will have to limit procedures using high volumes of irrigation fluid. It has enough fluids for emergency operations and cancer surgery, but the hospital is suspending some urological and joint procedures that are not considered time-sensitive.

“These are difficult choices for us to make,” Adams said.

Hospitals usually keep it for about a week IV fluids on hand, said Chip Kahn, chief executive of the Federation of American Hospitals, which represents for-profit facilities. This is partly because facilities want to make sure they use up all their supplies and the drugs are fresh.

The impact of the hurricane is sparking a broader discussion about how the federal government and the health system can avoid future disruptions in the supply chain.

“It takes a lot of time and effort to think about how you anticipate these problems or at least anticipate ways to solve them,” Kahn said.