Why hospitals are likely to see IV fluid shortage for some time

Many hospitals are making plans to deal with the shortage of sterile intravenous fluids, and officials say conservation strategies are going to be needed for the near future.

Flooding from Hurricane Helene inundated a Baxter International plant in western North Carolina, and that plant produces more than half of the IV solutions used nationwide. Baxter is working to ramp up production at other facilities, and the company this week launched a webpage to help health systems with resources and managing supplies.

Tom Cotter, the executive director of Healthcare Ready, a nonprofit group that works to ensure the availability of medical supplies in emergencies, says hospitals will likely need to continue to manage stores of IV fluids carefully for some time.

Federal officials are working to help obtain more IV fluids, but Cotter tells Chief Healthcare Executive® that it’s going to take a while before health systems see some relief. Even if more supplies come from abroad, they won’t arrive overnight.

“It's a liquid and it's heavy, so it's really difficult to fly significant and substantial quantities to ease a national shortage of IV solutions,” Cotter says. “So it's all going to be floated by boat, which can take some time.”

More than 8 in 10 healthcare providers (86%) say they are experiencing shortages of IV fluids, according to a survey released Thursday by Premier Inc. Nearly 17% of the providers surveyed said they have postponed elective surgeries, and another 58% of the participants said they’re considering delaying procedures in the future.

Last week, Xavier Becerra, the U.S. secretary of health and human services, told healthcare leaders that they could see constraints in supplies of IV fluids for weeks.

Federal officials are working to find suppliers who can produce more IV fluids, Becerra said in a letter to industry leaders.

Paul W. Abramowitz, CEO of the American Society of Health-System Pharmacists (ASHP), wrote in a letter to members last week that the organization “anticipates IV fluid shortages will persist for several months; during this time, conservation will be essential.”

Given the need to ship more supplies from overseas, Cotter says there isn’t a quick fix to the problem.

The Baxter plant produces 60% of the IV fluids used nationwide, or about 1.5 million bags per day, according to the American Hospital Association. And the plant has been offline for more than two weeks.

“There is no silver bullet for this,” Cotter says. “This is going to take multiple strategies to mitigate the impacts of this, whether the plant comes online tomorrow or it comes online in December. There needs to be a multi-pronged approach to ensure that this doesn't significantly impact patients.”

It’s also not easy to find other suppliers capable of producing IV fluids, and it can’t be done at the flip of a switch.

“Something as specialized as sterile, fluid IV solution, there's a massive barrier to entry there,” Cotter says. “It's not like any company can just start up this. This is a really specialized manufacturing process that requires a lot of robots and upfront investment that most companies cannot do.”

“It's difficult because of the sterility,” he explains. “A company that produces it has to 100% guarantee sterility of the product inside the bag, and that is insanely difficult to do.”

Baxter has said the company hopes to approach full production levels at the North Carolina plant by the end of the year.

Cotter says the healthcare industry avoided a more damaging blow to IV supplies when another key plant in Florida avoided major damage from Hurricane Milton, which hit the state last week. B. Braun Medical, which owns the plant in Daytona Beach, said the facility didn’t suffer any serious problems, as the Associated Press reported.

The disruption tied to the Baxter plant going offline offers yet more evidence that the healthcare supply chain needs substantial improvement, Cotter says.

While Cotter says it’s not ideal for the bulk of key medical supplies to come from any one plant, he also says he understands the business realities that prevent companies from opening a dozen separate plants to produce their materials. During the COVID-19 pandemic, health systems endured a host of shortages.

“I think there's a lot of conversation that needs to be had around how best to create more resiliency among up and down our supply chain,” Cotter says, adding, “There has to be an intervention somewhere to increase the investments into hardening and building resiliency.”

Over the past year, hospitals and health systems have encountered shortages of cancer drugs and bottles for blood cultures,

The American Hospital Association sent a letter to President Biden last week asking the government to obtain more IV fluid supplies and approve other measures to help health systems.

The association has asked the White House to invoke the Defense Production Act to spur manufacturers to produce more IV solutions and containers.

The Food and Drug Administration last week issued temporary guidance for healthcare providers compounding certain drug products in response to the disruption of IV supplies.