A limited supply of IV fluid, stemming from damage caused by Hurricane Helene, is forcing some hospitals across the U.S. to postpone elective surgery and other nonemergency procedures to safeguard their stock.
Catastrophic flooding from Helene struck a facility owned by the country’s largest IV fluid manufacturer, Baxter International, in North Carolina, leading to its temporary closure and reducing shipments to hospitals.
Adding to the anxiety, B. Braun Medical, the country’s second-largest maker of IV fluids, announced Tuesday that it would temporarily close two of its facilities in Daytona Beach, Florida, in anticipation of Hurricane Milton’s making landfall.
The Minnesota Hospital Association, which represents more than 140 hospitals and health systems across the state, has been holding daily calls since last week with hundreds of health care providers who are anxious about the limited supply and the timeline for when Baxter’s North Carolina facility will be back online, according to a spokesperson.
The UVA Health University Medical Center in Charlottesville, Virginia, is postponing some elective surgery Wednesday, Thursday and Friday to help conserve its supply of IV fluids, spokesperson Eric Swensen said.
Some elective surgery at UVA Health’s hospitals in Culpeper, Haymarket and Manassas was also being rescheduled, Swensen said, adding that they will monitor their schedules daily to determine which operations need to be postponed.
He also said the medical center has “doubled down” on efforts to prevent wasting IV fluid, as it’s the area’s only level 1 trauma hospital.
How hospitals are preserving IV fluid supply
Baxter accounts for about 60% of the IV fluid market in the U.S., and most hospitals in the country rely on its products, which are used to deliver drugs or water with electrolytes directly to a patient’s bloodstream.
IV liquids are essential during surgery — they keep patients hydrated, help regulate blood pressure and compensate for lost fluids, such as blood. Switching suppliers can be challenging for hospitals because of contracts that lock them in with manufacturers for years.
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To preserve supply, some hospitals are beginning to reschedule nonemergency operations, such as the removal of tumors that don’t require immediate treatment or heart ablation procedures for people with arrhythmias, the Minnesota Hospital Association spokesperson said.
A “gray market” is also starting to emerge, with people posting on Facebook that they have IV fluid bags for sale, although hospitals aren’t buying it, the spokesperson said. “It’s the wild wild West.”
Hennepin Healthcare, based in Minneapolis, has had to cancel or reschedule some surgical procedures, said Christine Hill, a spokesperson. She said patients are being notified.
“We are also in contact with other health care systems to coordinate efforts and resources as needed during this challenging time,” she said.
No new shortages declared yet
On Monday, the American Hospital Association, which represents 5,000 hospitals and health systems, sent a letter urging President Joe Biden to declare a nationwide emergency over the limited supply of IV fluids.
A number of IV products, including sodium chloride, dextrose and sterile water, have already been in short supply. The Baxter facility shutdown hasn’t led to any new IV fluid shortages yet, the Food and Drug Administration said Tuesday.
On Wednesday, the Department of Health and Human Services said the closure will “likely lead to further constraints.” In the meantime, it said, the FDA has permitted the use of compounded versions of the products in shortage.
Baxter is working with the Administration for Strategic Preparedness and Response (ASPR), an agency within HHS, to get its North Carolina factory back online.
Flooding from Hurricane Helene damaged bridges leading to the facility, but efforts to fix the plant appear to be progressing.
In an update posted on its website Wednesday, Baxter said its goal is to return to “90% to 100% allocation” of “certain IV solution” products by the end of the year. It also said that starting Wednesday, it’s increasing the allocation of its most in-demand IV fluids to direct customers from 40% to 60% and to distributors from 10% to 60%.
“Our goal continues to be to restore customers to 100% allocation levels as soon as possible,” the company said.
It’s unclear whether the end of the brief port strike across the East and Gulf coasts last week — which prevented products from being moved into the U.S. mainland — has helped with supply. Baxter has other facilities, including in Puerto Rico. It didn’t respond to a request for additional comment.
In its statement Wednesday, the company said its supply assessment was based in part on “anticipated timing of inbound products and shipments.” On Wednesday evening, the FDA said it was temporarily allowing for the importation of IV fluids from Baxter plants in Canada, China, Ireland and the U.K.
Zachary Dembner, a spokesperson for ASPR, said the agency is encouraging manufacturers and distributors to evaluate their supplies and asking health providers to implement conservation strategies to preserve their stocks.
On Tuesday, the agency also helped safely move IV products from B. Braun Medical’s Daytona Beach facilities out of the path of Hurricane Milton, Dembner said.
Those facilities — which were working with ASPR on supply — closed down Wednesday morning and are expected to resume normal operations Friday, Alli Longenhagen, a spokesperson for B. Braun Medical, said in a statement.
A delay in care
Hospitals are anxiously monitoring the situation.
A spokesperson for Enloe Health, a medical center in Chico, California, said it’s closely monitoring its IV fluid inventory to make sure it has enough for patients who need it. The center is also seeking out alternative suppliers.
Enloe Health had paused elective surgery. The spokesperson said it has since resumed “within certain clinical parameters.”
A spokesperson for RWJBarnabas Health in New Jersey said it has decided to pause a "handful" of elective procedures and has no definitive timeline on how long the procedures will need to remain postponed.
Shea Siegert, a spokesperson for the Alaska Native Tribal Health Consortium, said that no operations were being postponed but that providers were taking steps to preserve supply.
“ANTHC is proactively implementing conservation strategies to ensure continued availability statewide throughout the anticipated shortage,” Siegert said.
