Australia is facing a shortage of ‘crucial’ IV fluids. What does it mean and who will be affected?

The peak doctors’ body is warning the health system could come to a
grinding halt next week if an unprecedented shortage of intravenous (IV) fluid isn’t resolved.

The medicines regulator, the Therapeutic Goods Administration (TGA), issued a shortage alert on Friday for intravenous (IV) fluid products expected to be constrained throughout 2024, due to global manufacturing issues and an unexpected increase in demand.

The assistant minister for health, Ged Kearney, who is a former nurse, says IV fluids are “crucial” with “a myriad of uses” in the health system. So what are they, how are they used in hospitals and what’s being done about the shortage?

What are IV fluids?

IV fluids contain a saline solution – salt in water at a concentration which is similar to that of the plasma in our bodies. They are made under highly specialised manufacturing conditions using purified, sterile water with sterile electrolyte components. They also have highly specialised packaging and are designed to be compatible with intravenous giving sets to allow the fluids to be injected into a person’s veins.

What are they used for?

They are used to administer medications directly into the bloodstream, including chemotherapy and anaesthesia.

But the fluids can be crucial medicine in themselves to support kidney function in patients who are dehydrated and keeping the blood pressure up of patients with sepsis as well as blood loss.

As a result, the IV fluids are crucial for patients undergoing surgery with open wounds and haemorrhaging in emergency settings.

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.

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, says “while it’s physiologically OK for the red cell blood count to drop, it is essential to replace the blood volume”.

Organ injury, including to the heart, kidneys and brains, can occur if people become hypovolemic, where the loss of blood volume makes the heart unable to pump enough blood to the body, Story says.

How will patients be affected?

The president of the Royal Australasian College of Physicians, Prof Jennifer Martin, says there are workarounds when it comes to the use of IV fluids to administer other medications. “There are other ways to deliver medication besides diluting them in a bag of saline – such as oral fluids, or giving medicines as a slow push intravenous injection.” However, Martin says the IV fluid bags can be safer, and enable hospital staff to get on with other jobs.

There are not the same workarounds for surgery, Martin says, where the patient is not conscious and cannot drink, but is losing much more fluids from their open surgical site “because you’ve got, say the abdomen open, then you lose a lot of fluid that way”. However, the IV fluids are needed to deliver anaesthetics, and to keep patient blood pressure up during surgery as well as after an operation, she says.

As a result, the Australian Medical Association has warned some surgery may need to be cancelled. Non-cancer elective surgeries would probably be the first to be delayed in the event there was not enough IV fluid, Story says.

Is it just human health that’s affected?

Like humans, animals undergoing proceedures also require IV fluids. The president of the Australian Veterinary Association, Dr Sally Colgan, told the ABC the shortage was “very concerning” for vets, who have been facing supply issues in clinics.

What’s being done to address the shortage?

Kearney says the medicines regulator, the Therapeutic Goods Administration (TGA), is working hard to make sure there are alternatives.

In an effort to address 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 says it is advising them when new suppliers are approved.

The TGA says it is also liaising with the three Australian suppliers to address any regulatory barriers.