Hospitals face critical saline bag shortage: 6 things to know

Hospitals nationwide are experiencing shortages of small saline-solution bags due to supply chain disruptions at manufacturing plants in Puerto Rico after Hurricane Maria.

Here are six things to know.

1. Small saline-solution bags, which cost about $1.50 each, are a common medical supply clinicians use to deliver drugs intravenously. Cleveland Clinic uses the solution to administer 350 medications, similar to many other hospitals in the U.S., according to Bloomberg.

2. While saline supplies were already low before Hurricane Maria due to various manufacturing issues, the storm significantly worsened the shortage, leaving hospitals unsure if — or when — they'll receive a saline shipment.

3. Baxter International, the biggest supplier of large saline bags, has three manufacturing plants in Puerto Rico, which all lost power after the hurricane. The company has been using backup generators to gradually restore operations and is temporarily importing small saline IV bags from manufacturing sites in other countries to limit shortages.

4. Baxter is not the only saline manufacturer encountering issues. B. Braun Medical, another saline supplier, is at the center of a Food and Drug Administration investigation over reports of leaky and moldy IV bags, according to Bloomberg. A third supplier, ICU Medical, has been struggling to keep up with demand amid the other companies' decreased manufacturing capacity.Many manufacturers are rationing saline to prevent hospitals from buying up all available supplies, according to NPR. Baxter told customers in a Sept. 23 letter it would conserve the supply of many drugs produced in Puerto Rico — including IV fluids — by distributing fixed amounts of the products to hospitals based on their previous average monthly purchases, according to The Wall Street Journal.

5. Bonnie Levin, assistant vice president of pharmacy services for Washington, D.C.-based MedStar Health, told NPR Baxter reduced its saline distribution to 50 percent of its usual order.

"I don't think we're getting 50 percent, but we're getting sporadic shipments," she told NPR. "We used to get shipments every week. One of our hospitals got five cases of IV bags yesterday, and it was an order they had placed a month ago."

6. To mitigate the saline shortages, many hospitals are switching patients from intravenous drugs to the same medication in pill form or administering the drug through a syringe, according to NPR. These workflow changes are not only expensive and time-consuming, but also increase the chances for medical errors, clinicians told Bloomberg.

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