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An IV of sterile saline solution is a familiar part of patient treatment at hospitals. (iStock photo)

Md. hospitals adapt as national saline shortage continues

Most people who show up in the emergency room get hooked up to an IV of sterile saline solution in pretty short order. It’s standard procedure.

But for the past year, hospitals across the country have been making subtle changes to that procedure. Providers choose smaller-than-usual bags of saline, for instance, or they use different solutions that can serve the same purpose.

Patients probably don’t notice the changes, but they’re essential. Without them, hospitals from Maryland to California would be in crisis mode.

Why? A national shortage of intravenous saline solution (0.9 percent sodium chloride) has disrupted business-as-usual for hospitals, starting late last year and peaking in early summer.

Some experts had hoped the shortage would be resolved by now, but several hospital executives in Maryland and national experts agreed that’s not the case.

“The IV shortage is still very much going on,” said David Jaspan, director of pharmacy and materials management at Union Hospital of Cecil County in Elkton. “We’re working with physicians, with nurses to make sure we care for patients as appropriately as we can.”

Jaspan said he expects issues to continue for at least a few more months. And, according to Jaspan and others, a severe flu season could exacerbate the problem. So far this season, the Centers for Disease Control and Prevention has reported lower-than-usual incidences of the flu.

For now, hospital executives said they’ll continue to closely monitor their supplies of saline, ordering as much as they can and conserving the crucial solution as much as possible.

In general, patient safety is not at risk, hospital officials said, nor has the quality of care been diminished by the changes being made. But Jaspan acknowledged it’s possible that his hospital or others could run out of saline before another shipment comes in.

“We’re managing week to week, but it can get dicey,” he said. “We order [shipments of saline] once a week, and we’re pretty low by the end of the week. So it can be tough. There’s a possibility we won’t have what we need for a particular patient.”

Officials at Mercy Medical Center in Baltimore said they have managed to avoid shortages. Andrew Forest, the clinical pharmacy coordinator, said hospital staff have found ways to stockpile the bags of solution — even if that means paying more.

Mercy usually works with one distributor, but Forest said he’ll call around to other companies to see if they have product. If he catches them at a good time, he said, he’ll buy as much as he can.

Union Hospital and others are currently “on allocation” from their suppliers. That means the manufacturer gives hospitals a smaller shipment than what the provider usually receives.

Union has a contract with Baxter International, one of three major suppliers of saline. Jaspan said Baxter sent a notice earlier this month that the hospital was on 60 percent allocation — meaning the hospital will receive 60 percent of its usual shipment.

In July, Baxter had to recall a significant amount of saline because particles were found in some of the bags.

But Baxter isn’t the only manufacturer dealing with the shortage. The shortage began well before that recall, and the other two big players, Hospira Inc. and B. Braun Medical Inc., are struggling to meet demand.

Hospira and B. Braun are also allocating reduced quantities or are on back order, according to Bona Benjamin, coordinator of drug shortage resources at the American Society of Health-System Pharmacists.

A spokesman for Baxter said the company “has been the one continuous supplier of IV solutions” for more than a year.

“The company is making every effort to meet the needs of patients and customers in the face of increased demand for these products in the U.S.,” the spokesperson said in a statement, adding that solution is being produced “at maximum capacity.”

Baxter officials said they could not comment on future supply levels.

Hospira and B. Braun did not immediately respond to requests for comment.

Jaspan said he suspects the manufacturers have not been adequately investing in their production facilities, leading to quality issues like the one that resulted in Baxter’s recent recall. Other recalls have occurred due to leaks in the solution bags and other quality issues.

To help meet demand, the U.S. Food & Drug Administration has permitted some U.S. manufacturers to temporarily import solution produced in their facilities abroad. Experts say the additional supply has helped, but not resolved, the situation.

A permanent fix is still needed, especially heading into the winter months, Benjamin said.

“An increase in hospitalizations for flu has the potential to affect current scarce supplies unless manufacturers find a way to meet demand,” she said.

About Alissa Gulin

Alissa Gulin covers health care, education and general business at The Daily Record.