AMA warns surgeries may be cancelled due to ‘unprecedented’ shortage of IV fluids across Australia
Surgeries could be cancelled as soon as next week due to an “unprecedented” shortage of intravenous fluids in Australian hospitals, the peak doctors’ body has warned.
The medicines regulator, the Therapeutic Goods Administration (TGA), issued a shortage alert on Friday for multiple intravenous (IV) fluid products, which are used in surgery and critical care.
A TGA spokesperson said all states and territories were affected by the shortages of products from Australian suppliers.
The president of the Australian Medical Association, Prof Steve Robson, said “the health system potentially could come to a grinding halt next week if intravenous fluid isn’t available”.
Robson said local health authorities had warned of shortages as early as next week and those could have bigger implications than the Covid restrictions which led to non-urgent elective surgery being suspended at public hospitals.
“Covid restrictions were around staffing and preserving protective equipment, there was no shortage initially of supplies, but this kind of supply constraint is unprecedented,” Robson said.
“That would affect every surgeon, every anaesthetist and every patient awaiting surgery in the country.
“The number of patients potentially affected would be unbelievable,” Robson said, listing as potential problem areas anaesthesia, surgery, chemotherapy, emergency departments, paediatric intensive care, as well as the management of people with acute infectious illness in hospital.
The TGA spokesperson said supply was expected to be constrained throughout 2024, due to global manufacturing issues and an unexpected increase in demand.
Prof David Story, the president of the Australian and New Zealand College of Anaesthetists and head of the University of Melbourne’s department of critical care, said IV fluids were essential in emergency and ICU medicine such as when patients haemorrhaged or had sepsis. Patients can lose blood in surgery and experience body fluid loss from the operation.
An artery is filled with one-third red blood cells and two-thirds plasma, which IV fluids replace with similar concentrations of sodium and chloride.
“We’re worried about organ injury if people lose blood volume and they drop their blood pressure. Brain is at risk, heart is at risk, kidneys are at risk,” Story said.
Robson said he was scheduled to perform procedures next week but they would not go ahead if he did not have intravenous fluids.
If the situation played out as predicted fluids would need to be reserved for the most urgent cases and everything else would have to stop, he said.
Non-cancer elective surgeries would probably be the first to be delayed in the event that there was not enough IV fluid, Story said.
Hospitals would need to audit their needs and keep enough in reserve for patients who might suddenly need large volumes, he said.
“But it is also unsafe to try and minimise fluid therapy in those who may need it in orthopaedics. We don’t want those patients harmed because we’ve tried to overly restrict the fluids that we give those patients,” Story said.
In an effort to redress the shortage the TGA has allowed multiple overseas-registered alternative saline fluids to be imported, and is considering more applications for supply.
State and territory health departments directly manage supply in public hospitals, and the TGA said it was advising them when new suppliers were approved to import products.
Story said the shortage did not affect all hospitals uniformly.
“There’s a lot of uncertainty, and it varies across the different states and regions, and public versus private, so it isn’t just like there’s one problem affects everyone equally,” Story said.
The TGA said it was also liaising with the three Australian suppliers to address any regulatory barriers.
