10/17/2024

Considerations to Address IV Supply Shortages

Considerations to Address IV Supply Shortages  - shared from AAOMS

Following the Hurricane Helene flooding that led to Baxter International’s temporary closing of its North Carolina plant that produces 1.5 million bags of IV solutions per day, healthcare providers – including oral and maxillofacial surgeons – are facing shortages of these important supplies likely until the beginning of 2025. Some AAOMS members are reporting that supplies are already being rationed.

AAOMS’s Committee on Anesthesia, joined by the American Society of Dentist Anesthesiologists (ASDA) and the American Dental Society of Anesthesiology (ADSA), has developed the following considerations for practitioners during this national shortage.

1. Assess your current inventory and current pattern of use.
2. Contact your current vendor to find out how they plan to ration the distribution of IV solutions.
1. How much can you order at a time?
2. What is the frequency you can order additional IV solutions?
3. Consider alternatives to current patterns of use.
1. Would another anesthetic technique be appropriate (e.g., oral sedation with nitrous oxide)?
2. Keep in mind patient safety is paramount when considering alternatives (e.g., using the same IV bag/extension set on multiple patients increases risk of transmission of infectious diseases and is prohibited).
4. Consider encouraging PO hydration up to two hours prior to sedation (as per current ASA guidelines) especially in patients at high risk for dehydration (e.g., diabetics, patients on diuretics).
5. Consider whether the patient requires an IV infusion. If an IV infusion is not required, consider a saline/heparin capped angiocath. Alternatively, consider push-dose medication administration followed by saline boluses.
6. If deemed appropriate, and prefilled saline flushes are not used or available, the following illustrates a technique for push-dose medication administration:
1. Draw 50 cc from a saline bag using sterile technique.
2. May fill multiple syringes from the same bag but ensure “one needle/one syringe” per patient to prevent contamination of the bag of IV solution.
3. Bag of IV solution should be discarded 24 hours after first puncture of the bag.
4. Connect the 50cc syringe to an extension set attached to a three-way stopcock. (See picture below.)
5. Flush line with saline and attach to an angiocatheter.
6. Administer medications through three-way stopcock and flush with saline.
7. It is important to keep one to two bags of IV solution in reserve for medical emergencies.

Discuss with your staff the options to minimize saline usage including controlled irrigation.

Note: ACE SOUTHERN has created a quick order link for AAOMS members to order the products described above for push-dose medication administration: 50cc L/L syringes, 3-way stopcocks, and extension sets with side clamps.

While other sources of IV solutions may become available, practitioners need to anticipate that it may be 10 to 12 weeks before those additional sources of IV solutions become available to the private practice community.

Update from the FDA

• The FDA has issued an immediately-in-effect guidance, Temporary Policies for Compounding Certain Parenteral Drug Products, for compounders to help fill the gaps from the impact of the Baxter facility closing. The FDA also added three new drug products to the Drug Shortages Database as a result of Hurricane Helene. The agency now considers Dextrose 70% IV solution, Lactated Ringers IV Solution, and Peritoneal Dialysis Solution to not be commercially available in adequate supply to meet national demand.
• The FDA is working continuously to address the shortages and supply disruptions to ensure patients have access to certain parenteral drugs, including IV solutions. For the most recent information on drug and biologic products that were impacted by Hurricane Helene, visit the FDA’s Baxter Recovery webpage.

Considerations and Updates on Supply Chain Partners

• Work closely with your suppliers to understand restocking timelines and alternative options for procurement.
• Communicate regularly with supply chain management teams to coordinate bulk orders, if necessary.
• AAOMS Advantage Partner, ACE SOUTHERN, states its parent company Henry Schein is rationing impacted products to help preserve inventory. IV solutions products are currently being sold only to customers who historically purchased the product from either Henry Schein or ACE SOUTHERN from January 2024 to September 2024.
• ACE SOUTHERN is working with additional suppliers to obtain IV solutions products. Customers will have a specific allocation per item that can be ordered every five calendar days based on availability of inventory.
• ACE SOUTHERN representatives are available by phone to provide more information to assist customers with details about their allocations at 800-624-5926.

Other Resources

FDA Guidance on IV Fluid Shortages
ASA Suggested Actions
ASHP Guidelines on Managing Drug and Supply Shortages
Statement from Baxter
Update from Baxter

Please consider these steps to mitigate the impact on your patient care services. AAOMS is continuing to monitor the situation and will provide updates as more information becomes available. Thank you for continuing to provide quality patient care during this challenging time.