I am an Rn in a small outpatient chemo infusion center. The saline shortage is becoming a real problem for us. I am wondering what other small clinics like us are doing as far as infusion strategies during this severe shortage.
I'm in a hospital setting but we've moved to using 250mL bags for anything we'd normally use 50mL or 100mL bags for. Our 250mL bags are from mainland US but our 50 & 100mL bags come from a facility in Puerto Rico which is not running at capacity since the hurricane hit.
We just wonder if the other facilities will be able to keep pace with the need for this replacement until everyone is back in full swing.
Can't get Sterile Water, Lactated Ringers, or Normal Saline IV bags! Have been able to get some through local vet. You may also try getting empty bags and individual "bottles" of normal saline then fill the bags. I am adjusting IV solutions for osmolarity in my clinic it seems nearly once a week as I am having to use whatever I can get my hands on. D5W seems to be the only fluid left, but it really messes up your osmolarity levels as well as can cause precipitation! What a mess.
In our larger hospital we are doing a TON of IV push meds that used to be in bags. They are also using larger bags of fluids, pulling out the extra fluid and mixing appropriately (using a 1,000ml bag, pulling out the extra 500ml). Supposedly there is another country where the NS bags can be made, but it'll be 6+weeks before we can start importing them.
Oh jeez. There's a NS shortage now too? I guess it hasn't hit us yet. However the LR, Plasmalyte, Hydralazine, Bicarb, Protonix, Epi, Labetalol, Kphos, etc etc etc shortages sure have
. There is something wrong with this country when we are running out of essential meds regularly while the pharmaceutical industry sits raking in billions. But alas, I preach to the choir, I know.
Having same problem at our hospital too. Many of our ATB are coming in syringes now that we push over 5 minutes or more.
My facility is now running short on fluids in all sizes. We're giving IVPB meds as IVP, and no end in sight yet. Oddly enough, the only way that we knew about it was a sign from the distribution department that suddenly appeared in the medication room one day. Well, that and the ranting of the nurses.
We've been given guidelines for "judicious use" of fluids and medications. Anything that can be given PO, SQ or IM is. Many IVPBs are being given as IV pushes. I think we're putting things that can't easily be given IVP via syringe pump. We're DC'ing IV fluids as soon as possible and/or switching to the lowest rate possible if not able to go to PO.
I'm not on the floor but in the OR. I don't have a good "feel" for what our fluid situation is like. Anesthesia is using less wherever possible, but some situations do not allow for that. We're finding many medications are difficult to obtain - local anesthetics and many other meds are almost near impossible to obtain. Much of the production of local anesthetics occurs in Puerto Rico. We're using local that is different from our "go to" choices. In reality, while local is "nice" it's not required when a procedure is performed under general anesthesia. We do very few cases under local anesthesia only, so that's not a huge concern. We were already so short on bicarb earlier this year that we were not allowed to open any outside of a code or other resuscitation situation.
The bigger issue for us is that many of our supplies and implants are made partially or wholly in Puerto Rico. We aren't opening anything we don't absolutely need. Many of the things we need we're waiting to open until we're certain we need them. We're also making sure we have access to what we might need before elective procedures (specifically implants and staplers). There so many devices produced (or parts of devices are produced) in Puerto Rico.
I cannot imagine what it must be like to live in Puerto Rico right now. I know how inconvenienced we are...and cannot imagine what that level of devastation must be like. I've now seen a hurricane myself, that was devastating for us despite not being nearly as strong as what Puerto Rico experienced.
We're about to switch a bunch of our antibiotics to IVP. Here goes!
We're now being told we're short morphine and dilaudid...I'm like would you pharmacists mind telling that to my patients..
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