FILE - A nurse checks a patient's IV fluids at Providence Holy Cross Medical Center in Los Angeles in 2021. A North Carolina manufacturing plant that makes 60 percent of IV solutions in the U.S. was knocked offline by Hurricane Helene. Oregon hospitals are beginning to take measures to conserve supply.
Jae C. Hong / AP
Hospitals in Oregon are taking steps to conserve their supply of IV fluids, normally a cheap and readily available type of medications, after flooding from Hurricane Helene has knocked out a key U.S. supplier indefinitely.
The IV fluids in short supply are staple treatments in hospitals. They include saline, used for dehydration and wound cleaning; lactated ringers, a fluid used to treat electrolyte imbalances; and dextrose, used for low blood sugar.
The Baxter International factory in Marion, North Carolina, outside of Asheville, produces about 60% of the country’s daily supply of IV solutions. The factory and a bridge that provides access to it were damaged by historic flooding and a levee breach. The factory’s workers live in communities decimated by Helene, further slowing the reopening effort. A few are still unaccounted for, the company said.
Baxter has not given a timeline yet for when the factory will resume its operations.
For people working in health care, there’s a sense of deja vu, back to the acute shortage of masks and gowns when the COVID-19 pandemic disrupted the medical supply chain.
“It’s frustrating for hospitals to be at the mercy of a system where so much of the nation’s IV fluid supply is produced by just one manufacturer,” said Hospital Association of Oregon spokesperson Lisa Goodman.
“We need to do more to make sure these kinds of disruptions don’t happen in the future.”
On Monday, emergency medicine physician Dr. Alex Skog received a message from Providence, the health system where he works.
It was alerting providers that a potentially severe shortage of the most commonly used IV fluids is developing and could last for six months.
Skog, who works in the emergency department at Providence Willamette Falls in Oregon City, said so far he hasn’t run into any trouble ordering the fluids he needs for patients.
Health systems typically order IV fluids several weeks in advance and are working through supplies they stocked before the disruption.
But, Skog says, Providence is encouraging providers not to waste saline and other commonly prescribed IV fluids and to consider alternatives where possible.
Typically, Skog orders fluids when a person comes into the emergency room with nausea and vomiting, and looks like they might be dehydrated.
Now, he said, if a patient is stable, he’ll order IV anti-nausea medication and encourage them to drink more. The major drawback, Skog says, is just that it takes longer.
“To be honest, it’s not the preference of a lot of the patients that I see, but it’s just as clinically effective,” Skog said.
Samaritan Health Services, which operates five hospitals in the Willamette Valley and on the Oregon Coast, has also started conservation measures, including assessing patient’s fluid needs more often, switching to oral options as soon as clinically appropriate and using smaller bags when possible.
The health system typically keeps at least a two-week supply of high-use IV fluids on site, and has several more weeks ordered in advance with their distributor, according to Michael Arnold, Samaritan’s associate vice president of materials management.
“Our ability to replenish this supply is becoming difficult as any existing inventory dwindles,” he said.
Providence Health and Kaiser Permanente Northwest didn’t respond to a request for comment. OHSU spokesman Erik Robinson said it is following standard best practices to conserve IV fluids, including using oral rehydration when possible.
As the shortage builds, hospitals’ national lobbying group this week asked the Biden administration for greater flexibility to source IV fluids, including allowing them to prepare sterile IV solution in their own pharmacies and allowing international manufacturers to supply it.
Baxter, meanwhile, is limiting how much customers can order to manage its remaining inventory more fairly and prevent stockpiling.
So far, voluntary conservation of IV fluids has had a minimal impact on patient care, hospitals and providers say. Skog said if the shortage can be managed in the long run without needing more stringent restrictions on prescribing fluids, it won’t affect patients much.
But, Skog said, IV fluids are one of the most commonly prescribed medications in emergency medicine. It’s hard to know what to expect, given the scale of the disruption to the supply chain - and the uncertainty over how long it will last.
“If we are truly down to a few bags,” he said, “that would be disastrous.”
Editor’s note: an earlier version of this story misstated the region where Samaritan Health operates. Samaritan operates hospitals in the central Willamette Valley and on the Oregon coast.
