For a complete list of medicine shortages reported to the Therapeutic Goods Administration, see the TGA Medicines Shortage .
Intravenous (IV) fluid shortage
Updates
The national shortage of intravenous (IV) fluid bags across multiple suppliers is ongoing and anticipated to continue for the remainder of 2024.
Supply update
- The situation remains stable although supply may be constrained until the end of 2024. Judicious conservation of all fluids should continue
- Supply of sodium chloride 0.9% 1000mL and Hartmann’s solution 1000mL is expected to improve gradually from October and into 2025 as additional supply is secured. A reduction in usage of these product lines is encouraged. There is a more reliable supply of 500mL bag sizes; use these where 500mL is a clinically appropriate volume but avoid substitution with 2 x 500mL bags.
- Supply of sodium chloride 0.9% 50mL and 100mL bags is expected to be constrained for the remainder of 2024. Reduce the use of these products by using conservation strategies for vascular access devices and administration of medicines outlined in the Conservation strategies section below and the Australian Commission on Safety and Quality in Health .
- There has been increased usage of sodium chloride 0.9% 10mL ampoules. Discussions are being held with suppliers to facilitate continued supply.
- Public health services are to escalate any concerns or send enquiries to the contact emails provided at the bottom of this page.
Overview
There is currently a national shortage of intravenous (IV) fluid bags across multiple suppliers, with disruptions to supply expected to continue for the remainder of 2024. Products impacted include various brands and volumes of: sodium chloride 0.9% intravenous solution, compound sodium lactate (Hartmann’s solution) intravenous solution and glucose 5% intravenous solution.
A Clinical Advisory Group including representatives from Safer Care Victoria, the Department of Health, HealthShare Victoria and health services has been convened and is meeting weekly to monitor the situation and consider further measures to be implemented.
A National Response Group has also been convened to coordinate a consistent response across the jurisdictions and sectors.
Background
IV fluid bags are used for fluid maintenance, correcting or managing electrolyte imbalance, and as a diluent for compatible IV medicines. IV fluid bags are also used for the management of both arterial and central pressure lines.
Actions
Each health service is required to assemble a team of relevant clinicians and support staff to lead the management of IV fluid supplies at the health service level to:
- Review, assess and implement recommended conservation strategies, ensuring due consideration of appropriateness and safety
- Monitor data on IV fluid usage and stock holdings
- Provide reports on stock, usage and conservation strategies as requested
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The fluids in the following table are the products most at risk of shortages. Allocated supply of these products will be based on historical usage.
Description Volume Product Code Supplier Sodium chloride 0.9% intravenous solution 1000mL AHB1324 Baxter Sodium chloride 0.9% intravenous solution 500mL AHB1323 Baxter Sodium chloride 0.9% intravenous solution 250mL AHB1322 Baxter Sodium chloride 0.9% intravenous solution 100mL AHB1307 Baxter Sodium chloride 0.9% intravenous solution 50mL AHB1306A Baxter Compound sodium lactate (Hartmann’s solution) intravenous solution 1000mL AHB2324 Baxter Compound sodium lactate (Hartmann’s solution) intravenous solution 500mL AHB2323 Baxter Sodium chloride 0.9% intravenous solution 1000mL K690531 Fresenius Sodium chloride 0.9% intravenous solution 500mL K690521 Fresenius Sodium chloride 0.9% intravenous solution 250mL FAH1322 Fresenius Sodium chloride 0.9% intravenous solution 100mL FAH3015 Fresenius Sodium chloride 0.9% intravenous solution 50mL FAH3038 Fresenius Compound sodium lactate (Hartmann’s solution) intravenous solution 1000mL K694531 Fresenius Compound sodium lactate (Hartmann’s solution) intravenous solution 500mL K694521 Fresenius Glucose 5% intravenous solution 1000mL AHB0064 Baxter Glucose 5% intravenous solution 500mL AHB0063 Baxter Glucose 5% intravenous solution 250mL AHB0062 Baxter Glucose 5% intravenous solution 100mL AHB0087 Baxter Glucose 5% intravenous solution 100mL FAH3013 Fresenius Glucose 5% intravenous solution 250mL FAH0062 Fresenius Glucose 5% intravenous solution 500mL K691521 Fresenius Glucose 5% intravenous solution 1000mL K691531 Fresenius Glucose 5% intravenous solution (Viaflo bag) 250mL BSE0062 Baxter Glucose 5% intravenous solution (Viaflo bag) 500mL BSE0063 Baxter Glucose 5% intravenous solution (Viaflo bag) 100mL BSE0087 Baxter -
The Clinical Advisory Group, led by Safer Care Victoria, has developed recommended conservation strategies.
Health services are to review, assess and implement the recommended conservation strategies ensuring due consideration of appropriateness and safety. Refer to the Safety Considerations for further information.
IV fluids are used for 3 main purposes:
- IV hydration
- flushing and management of vascular access devices (VAD) and
- to administer medicines.
The conservation strategies described here have been grouped by area of practice and according to these main purposes.
General use
General advice
Review patients currently prescribed IV infusions and switch to alternative routes of administration as soon as clinically feasible.
Minimise fluid wastage by preparing fluids or infusions only when required, and not in advance.
Use a fluid type and volume that is most appropriate for the indication and current stock level (“most stock of at that time”). Seek advice from Pharmacy.
Ensure there are various sized pressure bags available for arterial and central line monitoring so that an alternative bag size can be used in the event of a shortage.
Do NOT use IV fluids for non-IV administration or use including off-label use (for example, wound flushing, eye irrigation or as traction devices).
IV hydration
Use oral or nasogastric routes of administration for hydration where possible.
Flushing and management of IV access
Use a volume of sodium chloride 0.9% most appropriate for current stock levels (“most stock of at that time”) for purposes of “drug and flush” or “to keep vein open” and VADs should be flushed, locked and capped where possible.
Administration of medicines
Use IV bolus injections or administration via a syringe driver.
Use alternative routes of administration such as oral, subcutaneous and intramuscular.
Use sterile Water for Injection ampoules instead of sodium chloride 0.9% for reconstituting IV medicines where compatible. Refer to the Australian Injectable Drugs Handbook for information.
Surgical patients
IV hydration
Minimise fluid fasting in surgical patients by encouraging clear fluids up until 2 hours prior to surgery. This may include instructing same day admission patients to drink water before leaving home and/or providing water on arrival if timing allows. The Sip Til Send protocol should be considered particularly for inpatients as surgery may be delayed. There are some patients to whom this guidance may not apply, such as those at increased risk of aspiration. For more information please review:
- Sip Til Send | Agency for Clinical Innovation (ACI)
- Fasting | Australian and New Zealand College of Anaesthetists (ANZCA)
- Guidance on sparing of intravenous fluid | Australian and New Zealand College of Anaesthetists (ANZCA)
Consider the need for routine use of IV fluids. Where postoperative IV fluids are necessary, consider the rate and duration of administration with review as required.
General advice
Consider indications for arterial pressure monitoring and sampling ensuring a clinical need exists.
Continue using irrigation fluid bags and bottles for peritoneal lavage and other body cavity lavage. The manufacturers have confirmed that these irrigation fluids have been produced and packaged with the same sterility standards as IV fluids but as they are intended for irrigation, they cannot be used intravenously.
Maternity patients
General advice
Do NOT use IV fluids for non-IV administration including off-label use (for example, heat packs)
IV hydration
Encourage oral fluids while in labour, as tolerated. Only use IV fluids where there is a clinical indication.
Maintain strict fluid balance for all women during labour and birth.
Review the need for post-operative fluids in women who can tolerate oral fluid intake.
Administration of medicines
Prepare oxytocin in a 50mL syringe, where possible. Review pump availability and medication library settings to assess feasibility for your health service. Consider using carbetocin as an alternative for post-partum prophylaxis post caesarean section.
Restrict tranexamic acid prophylaxis planning for women with post-partum haemorrhage risk. Administer 1g undiluted over 10 minutes.
Use antiemetics to treat hyperemesis and test oral fluid intake. Reserve IV fluids for severe cases.
Use ferric carboxymaltose (Ferinject®) for IV iron infusions. Inject doses of up to 500 mg undiluted at a maximum rate of 100 mg/minute. Inject doses of 500–1000 mg undiluted over 15 minutes. Slow IV administration is necessary to reduce the risk of extravasation and skin staining.
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General
Only use fluids labelled for intravenous use for injection or infusion. Ensure clinicians and staff involved in supply of fluids are aware that fluids marketed for irrigation are unsuitable for injection or infusion.
Use volumetric infusion pumps and other devices with in-line air detection where possible. Some alternative fluids manufactured overseas are being made available in Australia. These alternative products may be associated with a higher risk of air embolism due to a larger volume of residual air. Refer to the Clinical Excellence Commission factsheets for further information:
Digital configurations
Consider the need to adjust eMM/EMR settings and/or IV pumps to facilitate safe use of conservation strategies.
- Alerts to notify clinicians of supply disruption.
- Clinical decision support for medicine administration utilising smaller fluid volumes and/or alternative routes.
- Updates to the medication library on syringe pumps and large volume pumps to facilitate conservation.
Preparation of intravenous infusions of medicines
Ensure compatibility of IV medicines with the selected diluent and ensure the final concentration is within the acceptable range for administration/stability. Refer to the Australian Injectable Drugs Handbook and the Paediatric Injectable Guidelines via Clinicians Health .
Features of IV fluid bags, including overfill and maximum volume that can be added as well as comparison of constituents is available in the Australian Injectable Drugs Handbook.
Some medicines such as ciclosporin, tacrolimus and diazepam are incompatible with polyvinyl chloride (PVC) and some IV fluid bags may not be appropriate for administration of these medicines.
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Reporting
Report all IV fluid stock holdings to HealthShare Victoria (HSV) each week (by COB Wednesday). This includes a count of stock in Pharmacy / central store.
Escalate to HSV in circumstances where there is less than five days' supply for a product and there is not a clinically acceptable alternative available.
Collated state level data is being reported to health services on a weekly basis.
Stock allocating and ordering
Monthly and/or weekly stock allocations will continue to be communicated to health services each Monday via email from HSV to Directors of Pharmacy, Directors of Procurement and Supply Managers
HSV will work with health services individually to rationalise open orders.
HSV is investigating centralised distribution of Baxter IV fluids that are experiencing constrained supply.
Stock management
Limit stock levels held in clinical areas and conduct regular stock counts to inform escalations.
Reserve stock of the product in limited supply for use in circumstances where other volumes or fluids are not suitable.
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The Therapeutic Goods Administration (TGA) has approved overseas registered IV fluids under Section 19A. Refer to the TGA . Consider risk minimisation strategies to ensure the safe use of these alternatives, particularly given differences in presentation and volumes of air.
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Reviewed 19 September 2024