A member of the dialysis team prepares to treat a patient with COVID-19 in the intensive care unit at a hospital in Leonardtown on May 1, 2020. Photo by Win McNamee/Getty Images.
Maryland hospitals and health officials are keeping a wary eye on their supplies of sterile intravenous fluids after recent hurricane damage knocked out a major North Carolina-based manufacturer.
There have not been any disruptions to scheduled surgeries yet, but the Maryland Department of Health is encouraging facilities to conserve supplies and look to alternatives – just giving people fluids to drink in cases of dehydration, for example – until the supply chain can be restored.
“It’s very, very concerning,” said Dr. Mariana Socal, an associate professor at Johns Hopkins Bloomberg School of Public Health, of the shortage that is being felt nationwide.
“We are talking about something that is common. It is more than widely used – it’s universally used. And we depend on this to specifically treat the most critically ill patients in the most critical health care situations,” Socal said.
The shortage in IV fluids and related products is a result of damage from Hurricane Helene, when it battered areas of North Carolina in late September, including a Baxter International manufacturing site just outside of Asheville. That facility alone may supply around 60% of the nation’s IV fluids, according to some news reports.
Baxter’s North Cove facility flooded due to storm surges in the area and, in addition to damaging some inventory there, it shut down production and distribution of IV fluids used in a variety of medical situations. The company has limited allocations of available IV fluids and is pushing its other manufacturing sites to increase production in hopes of making up for the shortfall.
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The FDA said that several products delivered through IVs are “in shortage and may be further impacted until North Cove resumes operations.” Those include IV bags for certain saline solutions, dextrose solutions, and sterile water.
Chase Cook, communications official for the Maryland Department of Health, said in a statement Tuesday that the state agency is “working with hospitals, dialysis centers and other healthcare delivery partners to continue to manage the IV fluid shortage.”
“Supply chain disruptions are occurring across the country. State health leaders continue to be in close communication with federal partners, hospital leadership and other state agencies to determine where need is greatest, and to mitigate and respond to this issue,” Cook’s statement said.
In an Oct. 3 letter to providers, the department urged hospitals to conserve IV fluid supplies and seek alternative treatment methods when possible, among other precautions.
“These are simple solutions,” Socal said. “Often it’s about the sterile water mixed with the right concentration of salt or glucose (sugar).
“The problem is, chemically, even if these substances are simple, manufacturing is not simple. These fluids must be, number one, absolutely sterile, noncontaminated with anything,” she said. “So, that in of itself is very difficult.”
Socal said the shortage “does bring the need for very, very difficult decisions that hospitals must make, because they are literally everyday items. These are everyday products. They are the mainstay of patient care.”
Those decisions could mean postponing elective or less urgent surgeries, she said.
The Maryland Hospital Association said that hospitals in the state are impacted by the shortage but that there had been “no interruptions to scheduled surgeries” as of Thursday.
“Hospitals are conserving IV and other solutions that are in short supply,” Amy Goodwin, a hospital association communication official, said in an email this week. “We encourage Marylanders with non-emergency health concerns to consider alternative care options such as primary care, urgent care, or telehealth services.”
Michael Schwartzberg, a communications official for the University of Maryland Medical System (UMMS) said in a Tuesday statement that “at this time, there are no identified impacts to patient care.”
It does bring the need for very, very difficult decisions that hospitals must make, because they are literally everyday items. These are everyday products. They are the mainstay of patient care.
– Dr. Mariana Socal
“UMMS has secured vendors to provide an additional supply of our most critical supplies and has also identified clinical management options and best practices that could be implemented should we face continuing supply constraints,” he said in the statement.
The situation could change in Maryland, depending on how long the IV supply challenges last.
Dr. Georges Benjamin, executive director of the American Public Health Association, said the shortage is most likely to immediately affect those who receive medical treatment intravenously, such as dialysis patients and those undergoing chemotherapy.
He urges patients to talk to their medical providers to see if any of their regular medications that are typically administered through an IV may have to change for the time being.
“Anyone who routinely gets IV medications, check with their provider to make sure their schedule is staying intact,” Benjamin said. “And then if it isn’t, get an understanding of what’s changing, and have that conversation with your doctor.”
He also urged other people to avoid situations where they might need emergency services due to dehydration, such as when overheating, while the supply issues continue.
“If you have someone who is dehydrated, we very quickly put an IV in their arm and hydrate them. We might choose to hydrate them orally — have them drink lots of fluids,” if the shortage continues, he said.
“Drinking fluids is not a bad way to hydrate people … having said that, it takes longer. And then of course, if you have someone who’s really badly dehydrated and can’t drink, you have to do IV,” Benjamin said. “You’re going to have make some clinical decisions that are OK, but not the way you would normally do it.”