|Hospitals and healthcare organizations throughout Hawai‘i and the rest of the nation are feeling the effects of a normal saline (NS) shortage.|
|by William "Bill" Richter, RN; Authorized for reprint by Toby Clairmont, RN, CHEP, Introduction submitted by Jen Dacumos, PharmD, MBA|
Hospitals and healthcare organizations throughout Hawai‘i and the rest of the nation are feeling the effects of a normal saline (NS) shortage. The manufacturers state increased demand as the cause of the shortage. The shortage of NS has also caused the other IV fluids to become in short supply, including Lactated Ringer’s (LR) and Dextrose 5% (D5W). The three main manufacturers of NS (Baxter, B Braun and Hospira) have their supply on allocation and supply is estimated to return to normal levels sometime in April. Hospitals and healthcare organizations are encouraged to adopt aggressive conservation efforts outlined in the attached Healthcare Association of Hawai‘i (HAH) memo.
CURRENT STATUS REGARDING NORMAL SALINE SHORTAGE
Hospitals and healthcare organizations across the nation are experiencing shortages of 0.9% normal saline says a February 11, 2014, press release from the American Society of Health-System Pharmacists. The findings show that "more than 75 percent of the U.S. hospitals and other health care settings" are being affected. In addition, other products, including those used to conserve stocks of normal saline, are increasingly becoming scarce. Hawaii’s healthcare organizations are feeling the effects of this nationwide shortage as well.
HAH Emergency Services is monitoring the situation and is actively engaged in trying to work with local distributors and mainland manufacturers to secure additional supplies of normal saline. However, despite this effort, we believe that it will be unlikely that additional supplies can be obtained in the near future. Therefore, we are suggesting aggressive conservation efforts by all organizations that routinely use normal saline.
Below is a list of some of the actions your organization can take to conserve the current supplies of normal saline:
- Locate all remaining product in centralized and access controlled location (pharmacy)
- Review current IV orders and convert TKO or maintenance rate IV to Saline locks and PO where possible
- Review current order sets for "routine" IV starts, maintenance rates, and all other orders where IVs started per "routine" or "protocol"
- Switch IV solutions to D5W when possible
- Utilize Lactated Ringers or D5/0.45% NS solutions as a substitute for NS and D5W whenever feasible.
- Discontinue continuous IV fluid orders when clinically feasible and utilize oral hydration.
- Nursing staff should be encouraged to:
- Not spike fluids until needed.
- If fluids are spiked and not used, make an effort to use them elsewhere instead of discarding.
- Utilize 10 mL saline flush rather than liter bags to prime IV lines.
- Evaluate the need for keep vein open (KVO) fluids.
- Not change IV bags until entire contents of fluids used.
- Limit amount of IV fluids placed in warmers to avoid waste of unused bags.
The American Society of Health System Pharmacists also recommends the following strategies:
- Consider using oral hydration whenever possible.
- Consider using commercial dialysis solutions whenever possible instead of compounding with normal saline.
- Use smaller bag sizes for low rate infusions when possible. See the table below for suggestions. Use smaller bags and low flow rates as sodium chloride 0.9% is often used to keep an intravenous line open.
- Switch products to match availability. Consider using alternative fluids such as dextrose containing solutions or lower concentrations of sodium chloride that may be available (0.45%).
Suggested Bag Sizes for Specific Rates of Infusion:
20 mL / hour or less
21 mL/hour to 40 mL/hour