Shortage of IV fluids leads to canceled surgeries

Surgery was Katie Adase’s best chance at finally getting a diagnosis for the chronic pelvic pain that has been plaguing her for years.

“I couldn’t do laundry or walk to the grocery store or even cook without having to then take like three or four hours to lay in bed with a heating pad,” says the 26-year-old biologist. “It’s been really scary.”

But in October, a few days before her surgical procedure was scheduled to take place, a nurse called. The surgery was off because there wasn’t enough IV fluid to proceed.

“I was having such a hard time processing what she was even saying to me, that I was just really quiet,” she says, explaining that the procedure had loomed large in her mind because so many other doctors had given up trying to figure out what was wrong with her.

Her diagnosis would have to wait.

Canceled surgeries have been a problem for patients around the country in the aftermath of Hurricane Helene. The storm flooded a Baxter International factory in North Carolina that was making 60% of the national supply of IV fluids, which are used routinely during many surgeries and procedures.

Conserving IV bags

Without the Baxter facility making IV fluids, hospitals can’t order as much as they normally would, according to the company.

So hospitals have had to conserve their supplies for the neediest patients. Sometimes, that means telling emergency room patients to drink a Gatorade or Pedialyte instead of getting an IV. But it has also meant canceling some surgeries.

“This shortage is still touching nearly every hospital in the country,” says Dr. Chris DeRienzo, chief physician executive of the American Hospital Association. “Now I’ve talked to hospitals coast to coast, border to border all over the country who are needing to engage in those kinds of measures.”

The surgeries most likely to be postponed or canceled include certain bladder surgeries, which require a lot of IV fluids, some heart procedures, orthopedic surgeries and things like Katie Adase’s diagnostic surgery.

But it varies from hospital to hospital.

Nancy Foster, AHA’s vice president for quality and patient safety, says all hospitals handle it a little differently, but it’s stressful no matter what.

“This, for many hospitals, comes on the heels of some other supply chain shortages. And of course, we’re still in this sort of emotional recovery from COVID,” she says. “There’s still a lot of people feeling some burnout. And so [the Baxter situation] added to that with this new shortage that no one expected.”

And the strain is even worse as the end of the year approaches, says DeRienzo. People get sick with winter respiratory viruses, and they schedule more surgeries because their health plans usually reset in January with new deductibles.

Crisis mode

At Massachusetts General Hospital in Boston, Dr. Paul Biddinger has handled disaster contingency planning for more than two decades as the chief preparedness and continuity officer.

He says the IV fluids shortage is a crisis.

“We have activated our emergency operations plan for the system,” says Biddinger. “And we’ve been in that mode now for weeks …, and that is all hands on deck. It’s the same thing we do for a hurricane or the Boston Marathon bombing or COVID.”

Biddinger’s hospital has been able to reduce IV fluid use by 50%, but it’s taken a huge effort. And procedures still get pushed off.

When it’s a knee or hip replacement surgery that gets canceled, sometimes the patient has been waiting months already, and rebooking can take time.

“And so they’re in pain, their risk of falling there,” Biddinger says. “There are very real consequences to patients and their families.”

Improving supply

Things are getting better as Baxter and the federal government work to bridge the supply gap while the North Carolina factory is cleaned up for a phased reopening.

The administration is invoking the Defence Production Act to help Baxter get the materials it needs for reopening. The Administration for Strategic Preparedness and Response and the Federal Emergency Management Agency also sent staff to rebuild a collapsed bridge to the facility, and the Food and Drug Administration allowed temporary importation of 19 different IV products from around the world in the meantime.

Meanwhile, Baxter says it hopes to resume some production of the highest priority IV fluids at the facility this week and is ahead of schedule.

But it will take time for that supply to hit hospital loading docks. And the Baxter facility won’t be back to full capacity until at least next year.

Still, some patients NPR spoke to say their canceled surgeries have since been rescheduled and happened without incident.

As for Katie Adase in West Virginia, her surgery has been rescheduled for Nov. 1. She says she’s lucky to have the support system she has, but patients are paying a price even if things work out in the end.

“So that leaves me to fix up all of my logistics,” she says. “So I’m racking up medical debt. I’m racking up debt from traveling. I’m feeling guilty that, you know, my husband took off work for nothing.”