Flu spike, saline shortages linked

WASHINGTON — A shortage of intravenous saline is causing hospitals and dialysis centers to scramble to manage their supplies of the commonly used solution.


Health care providers are asking doctors and staff members to use smaller IV bags and find alternatives, officials and executives said. Officials have not heard of facilities running out of saline, "but we know that hospitals are still reporting that they may only have a few days' supply," said Valerie Jensen, associate director of the drug shortages program at the Food and Drug Administration.


Since mid-January, the FDA received notices from "dozens of hospitals" each week about low supplies of IV saline, she said.


High demand has been prompted in part by an increase in flu cases in recent weeks. Many flu patients who are dehydrated need intravenous saline.


Frustration about the shortage led one hospital in the North to consider asking the government to release saline from its emergency stockpiles, said Bona Benjamin, a senior executive at the American Society of Health-System Pharmacists. She cited privacy concerns in declining to identify the hospital.


"The flu spike is what suddenly escalated it and made it worse," Benjamin said.


The FDA said it is working with the three manufacturers of intravenous saline solutions to address the shortage. The agency is looking into alternative sources, including overseas suppliers. Baxter Healthcare, Hospira and B. Braun Medical have stepped up production in response. Baxter spokeswoman Deborah Spak said the company increased its output and is managing inventory to supply customers with the most critical needs. It notified customers that normal production should be in place by the second quarter of the year.


"Baxter has been manufacturing solutions at maximum capacity in amounts exceeding those of prior years and is making investments to further increase supply in 2014," she said in a statement.
Manufacturers first notified the FDA late last year that they expected delays in filling orders, but they did not anticipate shortages, officials said. A sharp increase in demand in mid-January turned the delay into a shortage.


At Olathe Medical Center outside Kansas City, Kan., pharmacy director Phil Schneider said he sent a notice to medical staff members of the 230-bed hospital two weeks ago asking them to "spread out the supply that we had." The hospital typically uses 280 cases of IV saline per month, with each case containing 14 one-liter bags. The hospital had about a five-day supply left. Schneider asked doctors to use 500-milliliter bags, among other steps, and as a result cut use by about one-third.


Buy by Monday, "we were again looking at shelves getting empty," he said. He sent out another notice about conservation.


On Tuesday, he received a shipment of 50 cases of saline, about a week's supply.


A spokeswoman for MedStar Health, which operates MedStar Washington Hospital Center and MedStar Georgetown University Hospital in the District of Columbia, said patient care has not been affected. But the health system is using smaller saline bags, looking for alternative IV solutions when possible, and reallocating saline across its system based on need.


Dialysis centers also rely on IV saline to cleanse their patients' blood. Many centers were notified about a shortage in the fall, and some took action to stock up on the solution.


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