IV Shortages Lead to Pause in Non-Emergency Surgeries

• A federal move typically reserved for wartime has been invoked to address the IV shortages in the United States.
• The Department of Health and Human Services is using the Defense Production Act to help the Baxter International IV fluid manufacturing plant acquire necessary materials after the site was taken out of commission by Hurricane Helene.
• The IV shortages are causing some hospitals and medical facilities to conserve their IV fluid supplies and, in some cases, pause non-emergency surgeries. 

A federal move typically reserved for wartime has been invoked to address the shortage of IV fluid supplies and production in the United States.

The Department of Health and Human Services is using the Defense Production Act to help an IV fluid plant based in North Carolina acquire “materials needed to clean and rebuild” its facility. The Baxter International facility was taken out of commission by Hurricane Helene. 

“[The Administration for Strategic Preparedness and Response] ASPR has issued a priority rating to Baxter for a remediation material they were unable to secure,” HHS stated in an Oct. 18 fact sheet. “This product was a limiting factor in their ability to restart production. ASPR is engaging with manufacturers to identify any other supply chain challenges that may require DPA authorities.”

As Baxter employees begin to re-staff the manufacturing plant and provide the IV materials, some hospitals and medical facilities are trying to scale back their IV use to spare their currently limited inventory. 

Recovery Status of the Baxter International Plant

The Baxter International manufacturing plant in North Cove, North Carolina, makes a majority of the country’s IV fluid. It was impacted by flooding from the hurricane. 

“Our local team has been tenacious in the face of daunting challenges, as we have advanced from site flooding and inaccessibility to deep cleaning and preparing equipment for restart– all in less than three weeks,” José (Joe) E. Almeida, Baxter’s chair, president and chief executive officer, said in a statement last week. “In parallel, we have transported more than 450 truckloads of undamaged finished products off site and to customers and have activated our global manufacturing network in support of our life-sustaining mission.”

As of Oct. 17, workers at the North Carolina site were returning to work “at levels nearing pre-hurricane staffing,” according to the company. Utilities and IT infrastructure also had been restored. 

Rationing Supplies & Postponing Surgery During IV Shortages

As the Baxter plant brings its production back to normal levels, hospitals are preserving their current IV supplies.

Dr. Jonathan Stallkamp, chief medical officer at Pennsylvania’s Main Line Health, told WHYY that the supplies are “as ubiquitous as a Band-Aid or a scalpel,” but his hospitals have been receiving less than half of their normal IV fluid supply.

Workers at his facilities have, in some cases, given patients Gatorade instead of an IV (if they’re still able to drink) or delivered medication via syringe and flushed with a “small amount of saline, which uses far less fluid than the usual practice,” the outlet reported.

“We right now have enough fluids on tap to be able to continue to provide surgeries,” Stallkamp said. “But we’ll continue to watch: There are many health systems across the country who have actually had to start to pause surgeries. And we are hoping not to be one of those.”

Colorado’s Banner Health is among more than a dozen hospital systems to do just that. The health system’s spokeswoman told the Denver Post that “some non-emergency procedures have been delayed or cancelled.” Nashville’s VA hospital also has cancelled or postponed procedures.

Representatives from the Massachusetts Nurses Association told Boston 25 News that there’s “some trepidation” surrounding the pausing of non-emergency surgeries.

“Let’s say you needed a heart valve. It isn’t emergent right now, but it’s having a huge effect on your care,” said Katie Murphy, president of the Massachusetts Nurses Association.

Five governors also penned a letter to the White House on Oct. 17 requesting that the following actions be taken: 

• Collaborate with the FDA to identify international manufacturers that can produce sterile IV solutions and their containers. 
• Extend the shelf life of sterile IV and peritoneal dialysis solutions that are nearing, or have already reached, their expiration dates but meet safety and efficacy standards. 
• Remove barriers that prevent the importation of sterile IV and peritoneal dialysis solutions. 
• The Federal Trade Commission and the Department of Justice should be on alert for price gouging related to the IV solution shortage.

The American Hospital Association and Society of Critical Care Medicine also have sent letters to federal officials related to the shortage. 

The Bottom Line

An IV shortage exacerbated by destruction from Hurricane Helene has prompted the invocation of the Defense Product Act — a federal move typically reserved for wartime. The facility that produces most of the IV fluid for the United States was knocked offline due to flooding from the hurricane, prompting some hospitals to cut back on IV fluid usage and pause non-emergency surgeries. 

Read More