Inpatient Practice

The 2017 Saline Bag Shortage

One of the casualties of Hurricane Maria was the Baxter Healthcare. Baxter makes supplies and fluids for intravenous therapy and also makes products for dialysis. One of Baxter’s manufacturing plants is in Puerto Rico. When the hurricane knocked out power to the island, the plant was not able to make products. The products that they make in Puerto Rico are small bags of saline known as “Mini-Bags” and “Viaflex Containers” and the Puerto Rico plant is the only manufacturing site for U.S. distribution of these products. These are plastic bags containing 50 ml or 100 ml of sterile saline. In the hospital, we use these in a number of situations: as a solution to run through IVs when the IV rate is KVO (“keep vein open” – a very slow rate with just enough saline going in to prevent the IV from clotting off, generally < 50 ml/hour) and when making an “IV piggyback” to put intravenous medications in. Although the Baxter factory is still functional, they are running off of generator power and curfew on the island limit them to running only 1 shift per day.

The background information is on the FDA’s website. Baxter has other manufacturing facilities in Ireland and Australia and the FDA has given permission for Baxter to import saline bags from those countries. But in the meantime, there are shortages and hospitals have to deal with the shortage. Here are some practical things that the hospital can do:

  1. For medications that can be pushed through a syringe (for example, low-dose furosemide), use a syringe rather than a small bag of saline.
  2. Eliminate the use of “KVO” IV rates and just cap off unused IVs with a saline well.
  3. Use 1,000 ml bags of saline instead of 250 ml or 500 ml bags (the 1,000 ml bags are not on shortage).
  4. Convert patients from IV to oral medications whenever possible.
  5. Eliminate IV fluids once a patient is able to take oral fluids.
  6. Instead of IV saline, use a different IV solution that is not in short supply, such as 0.45% NaCl, D5W, D5/0.9, D5/0.45, or Plasmalyte.

October 20, 2017

By James Allen, MD

I am a Professor Emeritus of Internal Medicine at the Ohio State University and former Medical Director of Ohio State University East Hospital