When Hurricane Maria hit Puerto Rico in 2017, not only did it devastate the houses and infrastructures in the island, it also wiped out United States’s substantial pharmaceutical supplier of IV bags, Baxter International. Due to this natural disaster, there are many adverse effects to our health care system.             

  1. What is an Intravenous Bag?  

Intravenous Bag (IV) carries intravenous solutions and are one of the most commonly used products in the hospital and some outpatient settings. Of all the intravenous solutions, the most common is the saline solution, which is comprised of salt water (9% normal saline) and according to the New England Journal of Medicine, more than 40 million saline bags per month are required by the hospitals for proper treatment.

  1. What is an Intravenous solution?  

When patients are admitted to the hospital, they are usually hooked on to the “drip” where a fluid from a plastic bag flows from the bag to the tube into the patient’s body. This “drip” is called intravenous solution. Three most common intravenous solutions seen in hospitals are:

  1. 9% normal saline: most common fluid of choice among health care providers as it works for hydration needs due to various health necessities such as: diarrhea, vomiting, etc.
  2. Lactated Ring: isotonic solution which contains potassium chloride, sodium chloride, sodium lactate, and calcium chloride. This type of solution is usually used on burn patients who have significant hypovolemic (loss in volume of water in the body) shift.
  3. 5% dextrose: Isotonic carbohydrate solution that contains glucose as its solute.
  1. Why are intravenous solutions necessary?

The main purpose of the intravenous solutions is to equilibrate hydration status in the body. Why is hydration status important? The main reason is because the human body is composed of 60% water, containing a  variety of electrolytes such as sodium, potassium, chloride, calcium, and magnesium. Imbalance in these electrolytes will cause muscle spasm, twitching, fatigue. Altering the body water volume will also cause changes in blood pressure which in long term will result in heart failure, kidney failure, liver and other organ failure.

Therefore, administration of the intravenous solution is vital in bringing the electrolyte and blood volume level in a normal range, so it doesn’t cause any adverse effects to the organs and the nervous system.  

  1. IV bag shortage and its effect in health care system:

According to New England Journal of Medicine, most drug shortages occur with older, generic, injectable medicines that are usually produced by three or fewer pharmaceutical manufacturing companies. Similarly, Saline bag is an inexpensive drug product that is currently only produced by three companies: Baxter International, B. Braun Medical, and ICU Medical. In conjunction, 50 % of the IV bags currently supplied to the American hospitals are from Baxter International.

What is the main reason of shortage?

Most shortages are due to quality of the product or production problems in the manufacturing facilities. Furthermore, if one supplier faces production shortage, then other suppliers usually don’t have enough manpower or money to make up the loss of the other company.

In the current case, when Hurricane Maria hit Puerto Rico in 2017, it also hit the largest IV bag production company, Baxter International.

Current problem:

Saline shortage along with the IV bag shortage causes many adverse effects on patients as discussed above. Medication errors and adverse effects occur due to health care providers utilizing more readily available, but less familiar substitution or when they administer intravenous push rather than the typical short infusion. According to the FDA, health care providers are being directed  to allocate their IV bag products to the most important patient cases and limit ordering excess IV bags until the supply is improved.

Fixing the problem:

As the New England Journal of Medicine states, fixing these shortage problems are difficult as neither Congress nor the FDA can force manufacturers to produce medication even though the IV bags are so essential and critical for the patient’s wellbeing.

References:

FDA Commissioner Scott Gottlieb, M.D., updates on some ongoing shortages related to IV fluids. News release of the Food and Drug Administration, Washington, DC, January 16, 2018 (https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm592617.htm).

“Saline Shortages – Many Causes, No Simple Solution | NEJM.” New England Journal of Medicine, www.nejm.org/doi/full/10.1056/NEJMp1800347