(USA Today) - As hospitals across the country cope with a bad flu season, they also must figure out how to deliver some medicines without an important tool of the trade, the intravenous fluid bag.
Hurricane Maria’s destruction of Puerto Rico, the key American manufacturing hub for medical supplies, triggered a months-long shortage in hospital essentials, especially IV fluids. Just as federal officials projected the shortage to ease, hospitals started seeing a spike in flu patients.
"It's unprecedented to have this kind of large-scale, nationwide drug shortage of such a basic item in U.S. health care," said Chief Pharmacist John Armitstead at Lee Health in Fort Myers, Fla. "So it's quite dramatic."
IV saline fluids in their ubiquitous plastic bags and tubes are a convenient way to deliver medication to a patient through an intravenous needle, allowing gravity to do the work and freeing nurses for other tasks. They are also used to hydrate patients.
Behind the scenes, hospital pharmacy departments have devised ways to reserve the 25-to-100 milliliter saline bags for use in patients whose condition requires them and adopt viable substitute procedures when possible.
In most instances, patients do not even realize the situation — and that’s what hospital staff strive to do.
“Our goal is to make that invisible,” said Scott Hufford, executive director of pharmacy for acute care services at Community Health Network in Indianapolis. “We want to manage it so that patients don’t know, providers don’t know.”
Hospitals have been using oral medications when they can, stopping IV bags once a patient no longer requires them and looking to Canadian suppliers to help fill the gap. Other methods include using a different sized bag when possible or swapping in dextrose for saline.
At Cincinnati Children’s Hospital Medical Center, which uses more than 1,000 IV fluid bags a day, patients have not noticed the difference, Chief Pharmacy Director Mark Thomas said.
“We’ve been able to manage the shortage very well,” he said. “I don’t believe that it’s been necessary to notify our patients or their caregivers.”
VA hospitals also are feeling the squeeze. At the Cincinnati VA Medical Center, nurses are delivering antibiotics through the push method. This process can take three to five minutes, time a nurse would otherwise have had to attend to other duties, but it saves using an IV bag.
Mercy Health, the Ohio-wide hospital system headquartered in Cincinnati, employs a variety of these methods as well as some other creative approaches to the shortage.
“In other cases, we can use larger bags that remain widely available or administer needed medications that come prepacked in frozen bags,” Mercy Health spokeswoman Nanette Bentley said.
Almost three quarters of Puerto Rico's manufacturing exports are pharmaceuticals and medical supplies. Baxter International Inc., whose plants in Puerto Rico produce 44% of the IV bags used in U.S. hospitals, sustained major damage from Hurricane Maria.
The FDA has said production at the plants, which now have intermittent power and back-up generators, is still "fragile" but should improve. Manufacturer B. Braun Medical Inc., which produces another 10% of bags used in the United States, also is facing production issues, some of which predated the hurricane.
Even though federal officials predict the IV-bag shortage will ease over the next two months, hospital staff on the mainland still are taking pains to conserve supplies.
Franciscan Health’s pharmacy originally was receiving only about 25% of its regular order from Baxter Health, said Ronda Freije, administrative pharmacy director for Franciscan’s central Indiana division. In late December, that rose to about 50%, but the hospital is not taking an increasing supply for granted.
“We’re maintaining our conservation efforts as much as possible, especially in light of incoming flu patients,” she said.
Contributing: Frank Gluck, The (Fort Myers, Fla.) News-Press; Kristi L. Nelson, Knoxville (Tenn.) News Sentinel. Follow Anne Saker, who reports for The Cincinnati Enquirer, and Shari Rudavsky, who reports for The Indianapolis Star, on Twitter: @apsaker and @srudavsky