In September 2024, Hurricane Helene damaged a Baxter International plant in Marion, N.C., that produces 60% of the U.S.’s IV fluid products, disrupting ASCs and other healthcare facilities across the country.
In a Sept. 29 report, the anesthesia department at Medical University of South Carolina in Charleston outlined their strategy for responding to the IV fluid supply chain crisis.
Here are seven takeaways from the report:
1. Starting Oct. 1, 2024, the anesthesia team began to quickly reduce IV fluid use before and after surgery by 60% by asking patients to continue oral hydration with clear liquids until two hours before procedures.
2. The anesthesia team found that patients showed up to their appointments more thoroughly hydrated than they did if they’d stopped drinking liquids the night before, per normal protocol.
3. “We created an algorithm for inpatient and outpatient procedures and surgeries to assist our teams when making resuscitation decisions. Our study focused on our ambulatory [outpatient] centers where we probably had the largest reduction in fluid administration,” Carlee Clark, MD, lead author of a study conducted by the MUSC team that focused on the IV fluid reduction plan.
4. The study covered a children’s surgery center, an ophthalmology center, an orthopedic ASC, a multispecialty HOPD and an endoscopy center. It found that certain patients and procedures did not automatically require a full IV fluid preparation.
5. Some patients received a “flush,” a smaller syringe of an IV fluid solution used after medications are given in the UV. Utilizing small flush syringes instead of full IV fluid bags was an additional way to conserve fluids during the shortage.
6. The study concluded that reducing IV fluids was not associated with significant increased rates of related problems like nausea and vomiting.
7. Dr. Clark and her team are applying some of the lessons they learned from managing the IV fluid shortage to their regular practice.
“In the past, we approached each patient with the same fluid resuscitation plan, typically starting with a one-liter bag of IV fluid in the holding room. Now, we use different-sized bags in different areas,” she said. “We changed our practice after learning during the fluid crisis. The change was not driven by cost but, rather, by making appropriate choices for patient care while conserving fluids and decreasing waste.”
