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Shortage of saline causing hospitals, dialysis centers to scramble to manage supplies

High demand for intravenous saline, prompted in part by a spike in flu cases in recent weeks, pushes hospitals to find other solutions. (JIM YOUNG/REUTERS)

A shortage of intravenous saline is causing hospitals and dialysis centers to scramble to manage their supplies of one of the most commonly used drugs.

Healthcare providers are asking doctors and staff to use smaller IV bags and find alternatives, if possible, to cope with the shortage, officials and executives said. Officials have not yet heard of any facilities running out of the solutions, “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 has received notices from “dozens of hospitals” each week about low supplies of IV saline, Jensen said Tuesday. High demand for IV saline has been prompted in part by a spike in flu cases in recent weeks. Many flu patients who are dehydrated need intravenous saline.

Frustration over the shortage prompted one hospital in the North to consider asking the government to release saline from its emergency stockpiles, according to 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 also looking into alternative sources, including overseas suppliers. Baxter HealthCare Corp., Hospira Inc. and B. Braun Medical Inc. have stepped up production in response. Baxter spokeswoman Deborah Spak said the company has increased its production and is managing inventory to supply customers with the most critical needs. It has 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 FDA late last year that they expected delays in filling orders, but they did not anticipate then that there would be 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 out a notice to medical staff of the 230-bed hospital two weeks ago asking them to take a number of steps to “spread out the supply that we had.”

The hospital typically uses 280 cases a month of IV saline, with each case containing 14 one-liter bags. The hospital had only about a five-day supply left. Schneider asked doctors to use 500-milliliter bags, among other steps, and as a result cut usage by about one-third.

By Monday, however, “we were again looking at shelves getting empty,” he said. He sent out another notice about conservation. And then 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, 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 saline.

“We’ve not heard of anyone on the edge,” said Rich Meade, a spokesman for the National Renal Administrators Association, which represents dialysis providers.

Capital Dialysis in Northeast Washington typically treats about 90 patients a day, with each treatment requiring one 1,000-milliliter bag of IV saline, medical director Jay Ocuin said. He has directed staff to use the saline more wisely. He also has enough to last another four to six weeks, he said.

Alice Crites contributed to this report.

Lena H. Sun is a national reporter for The Washington Post, focusing on health.



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