As the flu season picks up, it’s troubling to read how hospitals across the U.S. are forced to deal with the nationwide intravenous (IV) bag shortage.
The problem is that when Hurricane Maria slammed into Puerto Rico last September, it forced the temporary shutdown of Baxter International’s manufacturing plants. Baxter produces more than 43 percent of the U.S.’ IV bags.
Puerto Rico’s power grid is being slowly restored and the last of three Baxter factories there that make saline bags and nutrient solutions was reconnected just before Christmas. Baxter, in a statement, said the plants are “making progress on the road to a full recovery” of operations and the company expects “to return to more normal supply levels for products made in Puerto Rico in the coming weeks.” The U.S. Food and Drug Administration said in a statement it believes shortages will start to ease over the next few weeks, but it cautioned that “the production situation in Puerto Rico remains fragile.”
Nonetheless, many hospitals are only getting half or two-thirds of what they order, and typically have only a few days’ worth of saline on their shelves. Erin Fox, who tracks nationwide drug shortages and heads the University of Utah health system’s drug information and support services, told the Associated Press its hospital system now has five to eight pharmacists a day working on nothing but managing shortages.
The worst shortage is for small saline bags. Hospitals use hundreds—or possibly thousands—of the IV bags daily to hydrate patients and to dilute antibiotics, painkillers and other drugs, then hang the bags from a pole so the mix slowly drips through a tube and into a patient's vein. Deliveries of those bags have been most unpredictable, David Chen, a pharmacy director with Promedica, which operates 13 hospitals in Ohio and Michigan, says in the AP story.
“Some facilities are getting virtually zero,” Chen says. “Other are having them trickle in. You never know what you’re going to get.”
Health leaders are pressing federal regulators and Congress to adopt new measures aimed at ensuring a steady supply of critical treatment products. For example, groups such as the American Hospital Association, American Society of Anesthesiologists and American Society of Clinical Oncology are urging Congress to examine whether it’s acceptable that some medications are allowed to be made at a single plant, according to a letter to some lawmakers, a Wall Street Journal article reports. They also are pushing to get regulators more information about the cause of shortages and congressional incentives to get more manufacturers involved in producing specific critical products—such as IV saline and drugs.
In the meantime, the IV bag shortage remains acute, as the Centers for Disease Control and Prevention reports the flu is widespread in 46 states, which puts this year on par with 2014-2015, which was the most severe flu season in recent years. Consequently, hospital officials, pharmacists and other staff have been devising alternatives and workarounds, training doctors and nurses on new procedures and options, and working the phones to try to contact secondary suppliers.
In the intensive care unit at Massachusetts General Hospital, nurses are using Gatorade to combat dehydration among patients, CBS News reports. The process takes four times as long as treatment that is normally delivered intravenously.
Shortages are also hitting surgery centers, cancer clinics that infuse chemotherapy, dialysis centers and companies that provide regular infusions to home-bound patients. For example, although nutrient solution bags are needed for far fewer patients than saline, supplies are running low and there are few substitutes, Connie Sullivan, head of research and innovation at the National Home Infusion Association, says in the AP story. As a result, association members have been swapping products with other infusion services and even limiting the number of new patients they accept, she says.
“I have never seen anything quite this bad,” Sullivan says.
What are your thoughts on shortages of critical medical products and drugs? Would government incentives entice manufacturers to produce these products?