If you have had general surgery before, you will likely receive intravenous (IV) fluids.
A global shortage of many intravenous fluid products has prompted Australian health authorities to maintain stock levels in hospitals, while veterinary clinics across the country are already experiencing shortages of these products.
What are the uses of saline solution?
Sodium chloride – salt, commonly known as saline – and sodium lactate solutions are some of the fluids in short supply around the world.
Intravenous fluids are used to treat common medical conditions or mixed with other medications.
It is particularly vital in the treatment of sepsis and dehydration, and is used during resuscitation, post-anaesthesia care and intensive care.
Federal Assistant Health Minister Jed Kearney described saline as “one of the essential fluids” and a “fundamental part of care” in Australia’s health system.
What is the cause of the shortage?
The Therapeutic Goods Association (TGA) says “manufacturing issues and unexpected increases in demand” are to blame for the shortage of saline and fluids.
There are three ‘sponsors’ registered with the TGA to import, export or manufacture the affected intravenous fluids.
A spokesperson for one of those sponsors, Baxter Healthcare, said it had seen “a significant increase in demand for sterile liquid products in Australia due to multiple external factors, including increased customer demand and limited supplies, partly due to power outages from other suppliers.”
Baxter Healthcare did not respond to questions from the Australian Broadcasting Corporation about the source of this increased demand for intravenous fluids, or where the disruptions in the supply chain occurred.
How will I be affected?
A Baxter Healthcare spokesperson said they are “prioritizing the continuity of supplies to hospitals.”
The president of the Royal Australasian College of Physicians, Professor Jennifer Martin, described fluid deficiency as a “major problem” because of the vital nature of fluids and the uncertainty about when the deficiency will end.
There are different approaches that federal and state governments, health authorities and health care professionals use to address supply issues, the clinical pharmacist said.
Professor Martin said most hospital patients would not be aware of the shortage, as healthcare workers could use other methods to deliver many drugs, such as “slow push” into an IV and oral administration.
“Sometimes we use intravenous fluids to give medication, which is probably not necessary, but it helps our workflow because we can dilute our medication and then do other things for the patient,” said Professor Martin.
“We just ask people to use [IV fluids] Where it is desperately needed.”
Not just humans
Intravenous fluids are given to animals of all shapes and sizes by veterinarians in small animal clinics, production animal practices, and equine practices.
Fluids help animals maintain blood volume during general anesthesia, during serious surgeries, and after trauma such as car accidents.
Australian Veterinary Association president Dr Sally Colgan said the shortage was “very concerning” for vets, who were facing supply issues at clinics.
“We’re definitely seeing problems, and what we’re seeing is a shortage of the types of routine fluids that our practices use,” she said.
Small animals may only need half a liter to a liter of intravenous fluids, but a horse may need 3 to 5 liters per day to maintain blood volume, Dr. Colgan said.
For veterinarians already understaffed, the lack of these vital fluids is an additional stressor.
“It is important for our clients to realise that veterinarians are under this pressure and are doing everything they can to make sure your pet or animal gets the best possible care, but these are difficult times for us,” said Dr Colgan.
Did the authorities expect this shortage?
Australian health and veterinary authorities have issued guidelines for managing fluid deficiency since June.
A Tasmanian Department of Health spokesperson said the department had raised concerns with the Therapeutic Goods Administration more than 18 months ago.
what’s going on?
The Therapeutic Goods Administration has approved the import of alternative saline fluids registered abroad to address the shortage, and is considering further steps if necessary.
In an email seen by the Australian Broadcasting Corporation, the South Australian Ambulance Service banned the use of saline in training scenarios and advised paramedics to use the solution “judiciously” to reduce waste.
Health authorities in South Australia and New South Wales have directed staff to review and maintain stock levels.
The Tasmanian Department of Health and the state’s hospital pharmacy have formed a partnership to create a “small buffer” of fluids, while the department is still seeking federal participation.
“Given the potential impact on service delivery in hospitals, the Department of Health continues to advocate for this issue to be addressed at a national level,” a Tasmanian Department of Health spokesperson said.
Queensland Health has set up a working group to ensure supplies continue across the state, but a spokesperson did not detail what measures have been taken.
An ACT government spokesperson said its health department was working with other health services to provide regular updates and share stocks as needed.
“These services have processes in place to manage stock purchasing, stock movement and daily review of intravenous fluid use,” a Canberra Health spokesperson said.
A Northern Territory Department of Health spokesperson said it was aware of the ongoing supply disruption but there had been no direct impact on its hospitals so far.
Dr Colgan said the association had directed vets to review their use of intravenous fluids, as well as working with the Australian Veterinary Pesticides and Medicines Authority – the animal equivalent of the Therapeutic Goods Authority – to distribute fluids overseas here.
When will the show be back to normal?
A Therapeutic Goods Administration spokesman said intravenous drug supplies were likely to be “constrained” for the rest of the year, while a NSW Department of Health spokesman said normal supplies were expected to resume in the coming months.
This shortage has put the spotlight back on the issue of drug manufacturing in Australia.
Australian Medical Association President Professor Steve Robson said the federal government had made efforts in recent years to address drug shortages, but the shortage remained a “serious problem”.
“The Therapeutic Goods Administration is doing a good job of coordinating responses to serious shortages, but what is missing is a comprehensive strategy to ensure the supply of medicines at all stages of the pipeline,” he said.
Global manufacturing issues were most acute in Australia and New Zealand, Professor Martin said.
“We are the end of the supply chain for many of these customers and do not have the capacity to manufacture back-up for many of the medications and intravenous fluids that we use across Australia and New Zealand,” she said.
