The hurricane in Puerto Rico is leading a shortage in saline bags

“Doc, you mind switching that to an oral preparation?” our clinical pharmacist inquired during multi-disciplinary rounds as intravenous infusion devices beeped annoyingly in the background.  Taking care of ICU patients can be extraordinarily complicated, so doing it as part of a team helps make sure that all bases are covered.

Like many hospitals, ours uses a multidisciplinary model which makes rounds on all patients in the ICU.  An ICU nurse, clinical pharmacist, dietitian,  social worker, pastoral care, respiratory therapist, each provides important insight and perspective that guides patient care in the right direction.

As a pulmonary, critical care physician, I’m lucky to have a great team, so my ears perked up when I heard the suggestion. This was now the third patient he had suggested to switch a medication to the oral route from the intravenous route. Over the past few years, we’ve been experiencing a lot of spot medication shortages either because of inadequate supply, or because of precipitous price increases; we can usually change to an alternative. But today was different. Today we were switching a number of different medications, all of which were intravenous to oral formulations of the same or similar medicines.

“It’s not the medicines,” he replied, “It’s the bags they’re in.”

If you follow medical news, you may have heard about a shortage in the supply of saline bags. The segment alone is a $1.2 billion per year business. But while that “shortage” leads to a tightening of supply, health care providers could adjust with minimal impact.  We may not be able to adapt to this shortage as easily.

When hospitals administer medications, anything from electrolytes to antibiotics, they’re typically mixed with sterile saline in a  sterile bag by a pharmacist. That bag is then delivered to the nurses, who then run it through the bedside infusion device. Once the device completes the infusion, it is of course obliged to beep. Beep annoying, repeatedly, incessantly until a nurse pushes some magical combination of buttons to turn it off or puts up another bag to run in. We’re running out of those bags, the magical bags that make IVs stop beeping, because the island where many of them are manufactured was just ravaged by a hurricane.

Manufactured by Baxter, the supply of the sterile bags our hospital uses has dwindled since Puerto Rico was hit by the hurricane. Neighboring hospitals are going through similar problems, and we are all making do as best as we can.  Our incredible pharmacists continue to adapt to this latest shortage as they have with every other one: with intelligence and creativity. We can only hope that they keep coming up with ways to avoid patients being affected by these shortages, and preventing the beeping of IVs from driving us all mad.

Deep Ramachandran is a pulmonary and critical care physician, and social media co-editor, CHEST. He blogs at CaduceusBlog and ACCP Thought Leaders, and can be reached on Twitter @Caduceusblogger.

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