Alert: Critical IV fluid shortages continue

Michigan Medicine is experiencing continued shortages of intravenous (IV) solutions and medications as a result of the impact of Hurricane Maria in Puerto Rico.  

This shortage is unlike historical fluid shortages as it is not just affecting the U.S., but worldwide. Pharmacy, supply chain and several clinicians are proactively focused on adopting conservation measures in an effort to optimize the current supply and is actively identifying alternative options for medication delivery to maximize supplies.

The supply interruption is expected to last well into 2018. All efforts are being implemented to mitigate changes to clinicians and their workload. The organization's end goal is to continue to provide optimal patient care.

IV Mini Bags (50 and 100 ml) have been most affected (both 0.9% NS and D5% in water), but all IV solutions may eventually be at risk. This shortage is also affecting some medications since some drugs are manufactured pre-mixed in Mini bags. Also, there are about 40 drug manufacturing plants in Puerto Rico.

Please continue to implement the following conservation measures that apply to your clinical area:

• Do not open a new four-pack of small volume bags if a four-pack is already opened. Please use up all four bags, as they expire within 30 days once opened. This will help reduce waste. 

• Administer medication via IV push route, when available, rather than placing into IV bag for infusion. Contact pharmacy for rate of medication administration information when needed.

• Do not pre-order or locally stockpile IV fluids in your area; this will only exacerbate institutional shortages. Efforts to procure and institutionally store an appropriate inventory of IV fluids are taking place daily.

• Do not pre-spike IV bags or batching of fluids for procedures or daily usage.

• Alternate routes for medication delivery such as oral, IV push or syringe delivery will be implemented to conserve smaller volume bags. MiChart and Omnicell changes are being made as routes of administration change to allow for appropriate charting and medication supply.

Michigan Medicine will continue to monitor these and other expected shortages closely. Individual departments or providers may be contacted to discuss alternatives as this situation evolves.

If any staff have other suggestions for conservation of IV fluids please contact Sue Friebe at sfriebe@med.umich.edu or Janine Lee at jmamatan@med.umich.edu.

Thank you for your continued efforts and support during this shortage.