Shortages of I.V. Saline Affecting 76 Percent of U.S. Hospitals

Published Online: Tuesday, February 11, 2014

February 11, 2014 -- Critical shortages of i.v. saline solutions are affecting more than 75 percent of U.S. hospitals and other health care settings, according to a survey of pharmacy directors conducted by the American Society of Health-System Pharmacists (ASHP). Sodium chloride solution 0.9 percent, also called normal saline solution, is widely used in medical care, including treating dehydration, for patients receiving dialysis, and emergency care.

The online survey was sent to directors of pharmacy who are members of ASHP in early February. Preliminary results reveal:
  • 76 percent of respondents are experiencing a shortage of sodium chloride intravenous products.
  • While conservation strategies are working for 53 percent of respondents experiencing this shortage, 29 percent of respondents reporting a shortage have a supply inadequate to meet all patient needs.
  • Many respondents are also experiencing shortages of products that can be used as alternatives to normal saline solution, such as Lactated Ringers solution and dextrose/sodium chloride combination solutions.
    • The areas of care most frequently cited as heavily affected by the shortage include: Surgery and perioperative care (64 percent)
    • Emergency care (56 percent)
    • Hematology/oncology (21 percent)
    • Dialysis (20 percent)
    • Blood and blood component administration (14 percent)
    • Pediatric care (10 percent)
  • Respondents also report their organizations have been forced to switch patients to appropriate alternatives (64 percent), change patient doses (48 percent), prioritize patients based on clinical factors (29 percent), or even delay treatment for a patient (3 percent).
  • Respondents’ organizations are using a variety of strategies to obtain sodium chloride intravenous products. Examples include using tighter inventory control, such as reducing inventory on patient care units to better manage the supply (73 percent); obtaining supply from a secondary distributor (42 percent); compounding product in house, such as pooling or splitting different size containers or adjusting sodium chloride content of alternatives (20 percent); and using a compounding outsourcer to obtain product they cannot get from manufacturers (4 percent).

"While the survey does not point to patients being harmed as a result of the shortage, such a severe shortage of this widely used intravenous solution is extremely concerning,” said ASHP CEO Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP. “Hospital and health-system pharmacists are working very hard to provide the most effective care to patients during this shortage and it is important that all stakeholders work together to solve this crisis.”
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