Critical IV Fluid Shortage: Fluid conservation strategies

Situation: There is a critical national shortage of IV fluids and irrigation products, and we anticipate supply will be impacted. We are working on mitigation strategies to navigate this situation. 

Background:  Hurricane Helene damaged a Baxter manufacturing plant that supplies 60% of the IV fluids and irrigation solutions to the United States. These products include saline solutions, lactated ringers, dextrose containing fluids, Plasma-lyte, dialysis fluids and more. Efforts are being made by all fluid manufacturers and the FDA to increase the available supply of these products.

Assessment: Valley Medical Center receives the majority of our IV fluids from ICU Medical (Hospira) and as such the immediate impact of this shortage is not yet evident.  However, we are starting to experience supply chain challenges with some limited products we do procure from Baxter and do anticipate these IV fluid and irrigation shortages will impact Valley Medical Center.

Recommendation: Conservation is crucial. We are identifying areas throughout the organization where waste can be reduced, or use avoided. We need the help of all staff to conserve fluids when appropriate to ensure fluids are available for patients who require them. 

Please implement the following IV fluid conservation strategies to assist in managing this shortage:

• Avoid ordering TKO or KVO fluids – use a saline lock instead.
• Decrease rates as low as clinically possible.
• Discontinue IV fluids immediately once not needed. 
• Add an end time or end volume whenever clinically appropriate.
• Use PO medications whenever possible instead of IV.  The common list of medications pharmacists review for IV to PO conversion are listed below.
• Consider IV push pain meds/opioids vs. ordering PCAs whenever possible.
• Utilize oral rehydration for patients with functional GI systems. Order through room service when needed.Targeted Medications for IV to PO Conversion (each have >/= 90% oral bioavailability):

Acyclovir, azithromycin, doxycycline, famotidine, fluconazole, lacosamide, levetiracetam, levofloxacin, linezolid, metronidazole, pantoprazole, rifampin, valproic acid, voriconazole.   Ampicillin/sulbactam can also be switched to amoxicillin-clavulanate for most infections.

 If you have any questions, please feel free to reach out.  Thank you for your assistance and we will provide more updates as this situation evolves.