Navigating the Current IV and PD Fluid Shortage

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class="section-label__text">News</span> </p> <h1 class="header__heading hero-title">Navigating the Current IV and PD Fluid Shortage</h1> <p class="sub-head__date body-main--large">Oct 31, 2024</p> </div> </div> </div> <div class="js-share-modal one-column-view utility-bar-wrapper col-sm-12 col-md-8 col-md-push-3">  <input id="RedirectToLoginUrl" name="RedirectToLoginUrl" type="hidden" value="/membership/signin?returnUrl=%2Fnewsroom%2Fnavigating-the-current-iv-and-pd-fluid-shortage" /> <div class="content-detail__utility-bar js-utility-bar"> <button type="button" class="mobile-close js-close-modal close-icon"><span>×</span></button>      <div class="utility__item collection-list-wrapper js-collection-list-wrapper"> <p class="body-main utility__text js-redirect-to-login"> <span class="aacn-icon-lock"> </span> Add to Collection </p> <p class="js-added-to-collection added-to-collection body-main utility__text "> <span class="aacn-icon-check"></span> Added to Collection </p> </div> <div class="utility__item"> <p class="body-main utility__text no-click"> <span class="js-calendar-icon"></span> <span class="js-calendar-text"></span> </p> </div> </div> </div> <div class="col-xs-12 col-xs-12 col-md-8 col-md-push-3">  <main class="content-detail__main js-content-detail-main js-rail-position-top-anchor"> <div class="main__copy"> <em>AACN is actively monitoring the current shortage of intravenous (IV) and peritoneal dialysis (PD) fluids, sharing best practice recommendations and advocating on behalf of our community of nurses for support and prompt action.</em> </div> <span id="Content Page Html Paragraph" class="jump-anchor js-jump-link-anchor" data-title="Content Page Html Paragraph"></span> <div class="main__copy"> <h3>Navigating the Current IV and PD Fluid Shortage</h3> <p> The current shortage of intravenous (IV) and peritoneal dialysis (PD) fluids is impacting patient care across the country and limited resources are expected to continue through the end of 2024. Plans to mitigate the impact are essential and fluid conservation practices and policies must include the perspective of direct care nurses. AACN is actively monitoring the situation, sharing best practice recommendations and advocating on behalf of our community of nurses for support and prompt action. </p> <h3>What is the Situation?</h3> <p> On September 26, 2024, Hurricane Helene caused destruction and flooding in Florida, Georgia, North Carolina, South Carolina, Virginia, and Tennessee. The unexpected devastation inland included damage to Baxter’s North Carolina manufacturing site, a facility crucial to the supply of intravenous and peritoneal dialysis solutions. As the largest supplier (about 60% of IV fluids) in the U.S., the impact of the disruption in manufacturing and distribution is being felt across the nation. </p> <p> Only two weeks after Hurricane Helene, Hurricane Milton swept through Florida, compounding damage to the state due to storm surge, high winds, and flooding. Fortunately, the B. Braun plant in Daytona Beach was spared, and they are currently increasing production of fluids and medical devices to support the current need. Both Baxter and B. Braun are working with government agencies to increase product availability and timely distribution. </p> <p> The situation is improving; Baxter has activated their global manufacturing network to ramp up production at nine sites (imports from these sites have begun), temporary bridges are permitting transportation of products out of the facility, and they anticipate restarting the highest-throughput IV solutions manufacturing line the week of October 28, 2024. Production will occur in phases and they anticipate allocating 90%-100% of certain IV solutions by the end of this year. <a href="https://www.baxter.com/baxter-newsroom/hurricane-helene-updates" target="_blank">Baxter Hurricane Helene Updates are provided regularly on their website</a>. </p> <h3>Clinical Practice Recommendations & Support</h3> <p> A multilevel approach is needed to address the issue, limit disruptions to patient care, and keep patients safe. </p> <p> In general, recommendations include:<sup>1</sup> </p> <ul> <li> Carefully assessing clinical needs </li> <li> Assessing fluid responsiveness </li> <li> Discontinuing fluids as appropriate </li> <li> Identifying alternative sources of solutions </li> <li> Optimizing oral hydration when appropriate </li> <li> Engaging multidisciplinary teams </li> <li> Maintaining clear communication </li> </ul> <p> Recommended resources to help optimize the use of your IV solutions: </p> <ul> <li> <a href="https://www.nutritioncare.org/uploadedFiles/Documents/Guidelines_and_Clinical_Resources/Shortages/INS-Response-To-IV-Shortage.pdf" target="_blank">Infusion Nurses Society Recommendations</a> </li> <li> <a href="https://sccm.org/sccm/media/PDFs/Strategies-IV-Fluid-Conservation-2024.pdf?_zs=fKqvn1&_zl=EBfr9" target="_blank">Society of Critical Care Medicine Tip Sheet: Strategies for IV Fluid Conservation in the ICU</a> </li> <li> <a href="https://www.fda.gov/drugs/updates-2024-hurricane-season/hurricane-helene-baxters-manufacturing-recovery-north-carolina?mkt_tok=NzEwLVpMTC02NTEAAAGWeQrWYdH8tq7gmYWplpDbKiP4g-cKGzEag4VHhvlS-xCSBzA7Bnztc-t-U6ExCVw9Gs-UmL7BG5YufiKPUm3BsJ1IJIVY2SGsLHr6gFZ3U2GPaQ" target="_blank">US Food and Drug Administration Extended Use Dates for Some Parenteral Solutions</a> </li> <li> <a href="https://files.asprtracie.hhs.gov/documents/iv-fluid-shortage-strategies.pdf" target="_blank">Health and Human Services Recommendations</a> </li> <li> <a href="https://www.fda.gov/drugs/updates-2024-hurricane-season/hurricane-helene-baxters-manufacturing-recovery-north-carolina" target="_blank">Food and Drug Administration Updates</a> </li> <li> <a href="https://www.nutritioncare.org/IVFluidShortageResources/" target="_blank">ASPEN Recommendations</a> </li> <li> <a href="https://site.thoracic.org/clinicians-researchers/intravenous-fluid-shortage-ats-guidance" target="_blank">American Thoracic Society Recommendations</a> </li> <li> <a href="https://www.ashp.org/-/media/assets/drug-shortages/docs/drug-resources-conservation-strategies-iv-fluids.pdf" target="_blank">American Society of Health-System Pharmacists: Suggestions for Management and Conservation</a> </li> </ul> <h3>FREE CE activities</h3> <p> Take advantage of these free activities from NTI 2024 to help you manage your patient’s fluid status: </p> <ul> <li> NTI24304: <a href="https://www.aacn.org/education/ce-activities/nti24304/rose-and-the-four-ds-implementing-goldilocks-principles-in-fluid-resuscitation-and-therapy" target="_blank">ROSE and the Four Ds: Implementing Goldilocks Principles in Fluid Resuscitation and Therapy</a> </li> <li> NTI24361: <a href="https://www.aacn.org/education/ce-activities/nti24361/know-your-numbers-clinical-use-of-lactate-scvo2-and-dynamic-measures-of-preload-responsiveness" target="_blank">Know Your Numbers: Clinical Use of Lactate, ScvO2 and Dynamic Measures of Preload Responsiveness</a> </li> <li> NTI24279: <a href="https://www.aacn.org/education/ce-activities/nti24279/monitor-assess-intervene-using-hemodynamics-and-perfusionfocused-assessment" target="_blank">Monitor, Assess, Intervene: Using Hemodynamics and Perfusion-Focused Assessment</a> </li> </ul> <h3>Error Reporting Related to the IV Solution Shortage</h3> <p> If you are aware of any injury to a patient resulting from the shortage of intravenous fluids, please report the error to the <a href="https://home.ecri.org/pages/ecri-ismp-error-reporting-system" target="_blank">Institute for Safe Medication Practices</a>. </p> <p> Share what you are doing in our <a href="https://aacn.mobilize.io/main/groups/36700/lounge" target="_blank">AACN Online Community Forums</a>. Real solutions come from the frontlines! </p> <h3>AACN is Advocating for You </h3> <p> In collaboration with the Society of Critical Care Medicine (SCCM), part of the Critical Care Societies Collaborative, AACN advises our community of nurses to be aware of the plan at their hospital and to collaborate on the development of consistent standards guiding use of these fluids as limited resources. Key resources on fluid shortages and fluid stewardship can be found on the <a href="https://sccm.org/Clinical-Resources/globalhealth/Crisis-Response/IV-Solutions-Supply-Chain-Disruptions" target="_blank">SCCM IV Solutions Supply Chain Disruptions page</a>. </p> <p> In addition, AACN partnered with SCCM and nine other healthcare organizations to send a <a href="https://sccm.org/sccm/media/PDFs/SCCM-Joint-FDA-Letter-Baxter-Plant-Closure-10-10-2024.pdf" target="_blank">letter</a> to the Food and Drug Administration requesting prompt action to mitigate the resulting impact. This included a copy of a <a href="https://www.aha.org/2024-10-07-aha-president-urging-administration-take-immediate-action-address-iv-solution-supply-shortage-result-helene" target="_blank">letter</a> from the American Hospital Association to the current administration, expressing support of their recommendations to combat supply chain disruptions. </p> <p> We realize the importance of developing policy recommendations for the future and will collaborate with others committed to this work. Having systems in place to guide effective decision-making and help guarantee ethical triage and allocation of resources is crucial for patients and those that care for them. We will keep you updated as this work unfolds. </p> <h3>We Hear You</h3> <p> We recognize that this fluid shortage is incredibly disruptive to patient care. The impact is being felt across the country with clinicians facing difficult decisions about postponing or rescheduling procedures and surgeries, employing alternative hydration methods, and conserving the current supply of fluids. </p> <p> As you navigate this crisis in your day-to-day work, remember that you have the front-row seat to patient care. Continue to advocate based on individual needs and contribute to the overall plan by: </p> <ul> <li> communicating respectfully, honestly and openly; </li> <li> participating in educational training on managing fluid shortages; </li> <li> considering patient health and safety, along with the needs and resources of the organization; </li> <li> using assessment skills, critical thinking, and professional judgment for effective-decision making; and </li> <li> sharing your patient care expertise and seeking solutions as a team. </li> </ul> <p> Nurses need to be at the table and be forward-thinking in planning for future events. At University Hospitals, a 40% reduction in fluid use was necessary. When staff were encouraged to innovate using their own mitigation strategies, a 65% reduction in fluid use resulted.<sup>2</sup> </p> <p> “As nurses, we are experts in troubleshooting issues and prioritizing what’s important. We rise in times of crisis. Realize your value, share your experiences, and contribute your ideas,” states Vicki Good, DNP, RN, CENP, CPPS, chief clinical officer of AACN, “Your voice not only matters, it’s essential!” </p> <h3>References</h3> <p> 1. Society of Critical Care Medicine. IV Solutions Supply Chain Disruptions. Accessed October 29, 2024. <a href="https://sccm.org/Clinical-Resources/globalhealth/Crisis-Response/IV-Solutions-Supply-Chain-Disruptions" target="_blank">https://sccm.org/Clinical-Resources/globalhealth/Crisis-Response/IV-Solutions-Supply-Chain-Disruptions</a> </p> <p> 2. Twenter, P. University Hospitals needed to cut IV fluid use by 40%. It achieved a 65% reduction. Becker’s Clinical Leadership. Accessed October 30, 2024. <a href="https://www.beckershospitalreview.com/quality/university-hospitals-needed-to-cut-iv-fluid-use-by-40-it-saved-65.html" target="_blank">https://www.beckershospitalreview.com/quality/university-hospitals-needed-to-cut-iv-fluid-use-by-40-it-saved-65.html </a> </p> </div> </main> </div> </section> </div> </div>  <div class="reactDIV"> </div> <footer class="footer"> <div class="container"> <div class="row footer__top-bar"> <div class="top-bar__logo col-xs-8 col-xs-offset-2 col-sm-4 col-sm-offset-0"> <div class="aacn-logo-footer"><a href="/"></a></div> </div> <div class="top-bar__social-links hidden-xs col-sm-8"> <ul class="social-links__list"> <li class="social-links__item--facebook"> <a href="https://www.facebook.com/aacnface" target="_blank"><span class="aacn-icon-facebook"></span></a> </li> <li class="social-links__item--twitter"> <a href="https://x.com/aacnme" target="_blank"><span class="aacn-icon-twitter"></span></a> </li> <li class="social-links__item--linkedin"> <a href="https://www.linkedin.com/company/aacn" target="_blank"><span class="aacn-icon-linkedin"></span></a> </li> <li class="social-links__item--youtube"> <a href="https://www.youtube.com/user/AACNTube" target="_blank"><span class="aacn-icon-youtube"></span></a> </li> <li class="social-links__item--instagram"> <a href="https://www.instagram.com/exceptionalnurses/" target="_blank"><span class="aacn-icon-instagram"></span></a> </li> </ul> <div class="social-links__newsletter"> <a class="btn-flow" href="https://www.aacn.org/membership/myaacn/account?openpanel=js-panel-5#communications"><span class="btn-flow__label">Get Our Newsletter</span></a> </div> </div> </div> <div class="row footer-links"> <ul class="footer-list col-xs-6 col-sm-3 col-md-2"> <li class="footer-list__item"> <a href="/about-aacn">About Us</a> </li> <li class="footer-list__item"> <a href="/about-aacn/contact-us">Contact Us</a> </li> <li class="footer-list__item"> <a href="/about-aacn/board">Board</a> </li> <li class="footer-list__item"> <a href="/membership/membership-benefits">Member Benefits</a> </li> </ul> <ul class="footer-list col-xs-6 col-sm-3 col-md-2"> <li class="footer-list__item"> <a href="/newsroom">Newsroom</a> </li> <li class="footer-list__item"> <a href="/policy-and-advocacy">Policy & Advocacy</a> </li> <li class="footer-list__item"> <a href="https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=ec6b81f7-2d4c-453b-a9f4-8b56cfc4a899&ccId=19000101_000001&lang=en_US" target="_blank">Jobs at AACN</a> </li> <li class="footer-list__item"> <a href="https://solutions.aacn.org/" target="_blank">Enterprise Solutions</a> </li> </ul> <ul class="footer-list col-xs-6 col-sm-3 col-md-2"> <li class="footer-list__item"> <a href="/blog">Blog</a> </li> <li class="footer-list__item"> <a href="/aacn-theme">AACN Theme</a> </li> <li class="footer-list__item"> <a href="/give-aacn-a-gift">Give to AACN</a> </li> <li class="footer-list__item"> <a href="/bulk-discounts">Group Discounts</a> </li> </ul> <ul class="footer-list col-xs-6 col-sm-3 col-md-2"> <li class="footer-list__item"> <a href="/advertising-footer">Advertising</a> </li> <li class="footer-list__item"> <a href="/privacy-policy">Privacy Policy</a> </li> <li class="footer-list__item"> <a href="/terms-and-conditions">Terms & Conditions</a> </li> </ul> <div class="footer-store col-xs-12 col-md-3"> <p class="footer-store__text"> Browse books, pocket cards, practice tools, certification reviews, products and more </p> <div class="footer-store__cta"> <a class="btn-flow" href="/store"><span class="btn-flow__label">Shop Now</span></a> </div> </div> <div class="top-bar__social-links--xs visible-xs col-xs-12"> <ul class="social-links__list"> <li class="social-links__item--facebook"> <a href="https://www.facebook.com/aacnface" target="_blank"><span class="aacn-icon-facebook"></span></a> </li> <li class="social-links__item--twitter"> <a href="https://x.com/aacnme" target="_blank"><span class="aacn-icon-twitter"></span></a> </li> <li class="social-links__item--linkedin"> <a href="https://www.linkedin.com/company/aacn" target="_blank"><span class="aacn-icon-linkedin"></span></a> </li> <li class="social-links__item--youtube"> <a href="https://www.youtube.com/user/AACNTube" target="_blank"><span class="aacn-icon-youtube"></span></a> </li> <li class="social-links__item--instagram"> <a href="https://www.instagram.com/exceptionalnurses/" target="_blank"><span class="aacn-icon-instagram"></span></a> </li> </ul> <div class="social-links__newsletter"> <a class="btn-flow" href="https://www.aacn.org/membership/myaacn/account?openpanel=js-panel-5#communications"><span class="btn-flow__label">Get Our Newsletter</span></a> </div> </div> </div> <div class="footer-list center-blurb"> <p class="footer-list__item">© 1996 - 2024 American Association of Critical-Care Nurses. 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Navigating the Current IV and PD Fluid Shortage - AACN