In the News

Guidelines for conservation of IV fluid bags during supply chain disruption

Download Guidelines for Conserving IV Fluid Bags During Supply Chain Disruptions

Authored by: Mohsen Saidinejad, MD, MS, MBA

Due to the devastation caused by Hurricane Helene in Western portions of North Carolina, one of the main suppliers of IV fluid bags recently closed its operations. In the meanwhile, it is expected that a significant supply chain disruption and IV fluid shortage will affect many hospitals.  To this end, efficient use of existing supply of IV fluids, and reserving these for cases that are in most critical need is important. It is important to consider that most children who are mildly or moderately dehydrated or fluid depleted can be managed with oral rehydration.  Therefore, the use of IV hydration should be reserved in cases where a child is not able to be orally rehydrated, either to their level of consciousness, or lack of a functional gastrointestinal system.

Several institutions have developed interim strategies to address shortage of IV fluid base. Below is an example of guidelines and strategies to help hospitals conserve the limited supply of IV fluids from Los Angeles County.

1. Prioritize Usage: Reserve IV fluids for patients who cannot take oral fluids.
2. Minimize Waste: Monitor patients closely to avoid unnecessary administration or overhydration.
3. Use Substitute Products: Replace crystalloids with other available fluids when appropriate, and substitute with enteral or oral hydration where feasible.
4. Optimize Oral Hydration: Encourage oral intake when possible, using oral rehydration solutions (ORS).
5. Reduce Unnecessary Fluid Administration: Avoid fluid boluses unless indicated and review standing orders.
6. Use IV Push or Bolus Doses: Administer medications as IV push instead of diluting in IV bags, when safe.
7. Collaborate on Supply Sharing: Redistribute supplies within the hospital or system, or with neighboring facilities.
8. Modify Treatment Protocols: Minimize IV fluid use in protocols and use alternative routes for medication.
9. Limit Pre- and Post-Operative IV Fluids: Avoid routine use of IV fluids pre- and post-operatively if oral fluids are possible.
10. Educate Staff: Ensure all healthcare providers are aware of the shortage and trained on conservation measures.
11. Use of blanket extension for expiration dates on medications in shortage (LA County EMS Agency Reference 701).
12. Frequently assess the clinical need for continuing IV fluid therapy and discontinue infusions as soon as they are no longer necessary.
13. Automatically set initial infusion orders to stop at 24 or 48 hours, then reassess medical necessity after each order.
14. Reduce or discontinue the “To Keep Open” (TKO) line usage when possible.  
15. Use small- volume bags for low infusion rates to conserve larger volume bags.
16. Where possible, order IV push medications instead of IV infusions.

 

In addition to the resources below, please visit PPN’s Resource Central using the keyword “fluid therapy” for more resources.

Resources

 ASHP

 Health Care Ready

Baxter

ASPR-TRACIE