US hospitals strained by IV fluid supply limits after Helene hit production site

By Deidre McPhillips, CNN

(CNN) — Hospitals across the United States are rationing critical intravenous fluids and postponing some surgeries as the national supply chain continues to reel from severe disruptions triggered by Hurricane Helene two weeks ago. Now more threats – including respiratory virus season and another hurricane – are looming.

Baxter International’s North Cove site – in Marion, North Carolina, less than an hour east of hard-hit Asheville – is one of the largest manufacturers of IV fluids and dialysis solutions in the country. The site was “significantly impacted by the rain and storm surge” from Helene and temporarily closed, the company said.

After a brief pause, Baxter resumed distribution of supplies – but with significant restrictions on the amount that could be ordered.

Recent updates have brought some relief to health-care providers, but many hospital systems continue to operate under special protocols to conserve resources.

On Wednesday, Baxter announced that it was increasing allocations for the most in-demand IV fluids – to up to 60% of typical order volume. These allocations “help limit stockpiling and increase the likelihood of equitable access to available products,” the company said in a news release.

Allocations for IV solutions and nutrition products for children’s hospitals were restored to full capacity, and some other IV solution products could return to full allocation by the end of the year, Baxter said.

“The increase, and the promise for continuous increase, has tempered our level of concern, but the issues remain real,” said Nancy Foster, the American Hospital Association’s vice president of quality and patient safety policy.

Baxter supplies about 60% of IV fluids to hospitals in the US, and some rely exclusively on Baxter products. Although the US Food and Drug Administration has not declared any new shortages related to the effects of Hurricane Helene, the lack of production at the Baxter site could exacerbate the situation for some products that already were in shortage.

Dr. Paul Biddinger, chief preparedness and continuity officer at Mass General Brigham, said it’s too soon to tell whether the increased allocations from Baxter will have an effect on operations in his hospital.

Mass General Brigham hasn’t had to cancel any surgeries or postpone any care, he said, but the hospital is operating under an emergency operations plan that was also in place to respond to the Boston Marathon bombing and the height of the Covid-19 pandemic.

It’s also making substitutions to conserve supply when possible, including using the oral version of some medications instead of the intravenous option and offering patients Gatorade or Pedialyte to hydrate.

“The potential for this to affect operations is very significant,” Biddinger said. “This is very much moment-to-moment.”

The UVA Health University Medical Center has postponed some nonurgent elective surgeries through at least the end of the week “to help conserve supplies to minimize disruptions to patient care.”

“As the area’s only level 1 trauma hospital, the medical center is taking these measures to ensure care for its most critical patients,” UVA Health said in a statement.

Despite these challenges, providers don’t want patients to worry.

“We want them to feel reassured that they’re going to get the medical care they need, and we’re not changing the standard of care, but we may be delivering care differently,” Biddinger said.

Another storm may impact supply

On Monday, the American Hospital Association sent a letter to President Joe Biden urging the administration to take immediate action to increase the supply of IV fluids.

In a letter to health care leaders Wednesday, US Department of Health and Human Services Secretary Xavier Becerra shared an update on options that the federal government is considering to address the strain on supply, including alternative manufacturing sites, temporary imports and expedited assessment of these options.

HHS has also been working with other domestic manufacturers to bolster supply, but there’s a chance of another major storm “further disrupting an already fragile market,” Becerra wrote.

Another major US manufacturer, B. Braun Medical, has ramped up production of IV fluids at its sites in Irvine, California, and Daytona Beach, Florida. But the Daytona Beach facilities will temporarily close as Hurricane Milton barrels to the state’s west coast and threatens the safety of millions. In anticipation of the storm, finished products will also be moved to a secure facility farther north.

“The Daytona Beach facility is a key part of our plan to help address the shutdown of Baxter’s IV solutions manufacturing facility in North Carolina,” said Alli Longenhagen, director of corporate communications for B. Braun Medical. “We are focused on protecting our people and mitigating the impact of the storm on our IV solutions supply.”

‘Lifeblood’ for a variety of patients

IV fluids are used for a wide range of medical purposes. Some, like dehydration, can be helped with alternative methods. But others, like organ transplant surgeries, cannot.

“It’s the lifeblood of being able to treat so many different kinds of patients,” said Dr. Chris DeRienzo, chief physician executive with the American Hospital Association.

And IV fluid supply becomes especially crucial during respiratory virus season, which is quickly approaching in the US, he said. It becomes difficult to keep patients hydrated when they’re having trouble breathing, and IV fluids are often a first line of defense when severe cases of flu, Covid-19 and RSV cause a patient’s blood pressure to drop.

“We’ve still got 40% of the way to go, and that’s going to take a number of compounding efforts” to recover, DeRienzo said. “It’s only going to be from stacking hand upon hand upon hand, increased output from here, increased allocation there, to even get close to 100% of what the nation’s hospitals are used to working with this time of year.”

In 2017, Baxter facilities in Puerto Rico were severely affected by Hurricane Maria. Disruptions to the medical supply chain, particularly around IV bags used to administer and dilute medications, lasted months.

The major disruptions to the IV fluid supply after Hurricane Helene are the latest in a string of challenges that have exposed vulnerabilities to the broader US supply chain.

There were a record number of drugs in active shortage in the US in the first three months of 2024, according to data from the American Society of Health-System Pharmacists and the University of Utah Drug Information Service. The situation has improved somewhat in recent months, but there have been at least 300 active shortages for the past year and a half.

CNN’s Meg Tirrell contributed to this report.

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