patient safety & quality
patient safety & quality
By Kristina Pirollo , BA , AA , CHL , CRCST
Examining the Saline Solution Shortage in Healthcare
The COVID-19 pandemic has further raised the need for intravenous ( IV ) fluids , more so isotonic saline solutions , due to high hospitalization levels in health facilities . At the height of the pandemic , the utilization of IV fluids increased , and the research suggested that the hospitals needed more than 40 million bags of saline solution monthly ( Finfer et al ., 2022 ).”
The shortage of saline solution has become one of the most significant issues of global healthcare concerns for hospitals , worsened by the COVID-19 pandemic due to the increased demand for IV fluids for use in patients . Oral and intravenous use of saline is important in the management of patients with hypovolemia , septic patients , and patients who have metabolic alkalosis . This article discusses points to understand the factors that have led to the saline shortage , the impacts that it has , and the measures being put in place to ensure that patients continue to receive their saline products .
Causes of the Saline Solution Shortage
The COVID-19 pandemic has further raised the need for intravenous ( IV ) fluids , more so isotonic saline solutions , due to high hospitalization levels in healthcare facilities . At the height of the pandemic , the utilization of IV fluids increased , and the research suggested that the hospitals needed more than 40 million bags of saline solution monthly ( Finfer , et al ., 2022 ). This has particularly stretched the existing shortages even before the pandemic due to some other factors such as interruption of production and logistical delays . Natural disasters , such as hurricanes , for instance Hurricane Helene , have compounded these challenges through the closure and halting of production facilities , the North Carolina Baxter , for instance .
Manufacturing issues are further exacerbated by constant quality concerns in several suppliers , one of which is B . Braun , which was already having issues with maintaining steady production before the pandemic . New sources of supply chain constraints have been born from logistics and regulatory constraints that have slowed manufacturers ’ ability to satisfy growing demand . Such bottlenecks have contributed to the delay and lack of timely availability of saline solutions in hospitals ( Shukar , et al ., 2021 ). In monetary terms , saline solutions are low-margin products for manufacturers , who consequently showed modest interest in increasing production capacity .
Impact on Healthcare Delivery
The lack of saline solution has greatly affected the treatment process , forcing patients to wait and use other substandard methods that may not be of so much help . Hospitals have limited the immediate critical care requirements , generally not emphasizing other procedures to preserve the saline solution available . This has raised the challenge of providers using other fluids or oral hydration solutions that may not have similar therapeutic effects as saline . These difficulties have been addressed by the utilization of conservation measures like centralization of stock control of IV fluids and checking on stocks regularly
To overcome the issue of saline solution deficiency , physicians have been persuasive in prescribing oral rehydration solutions to patients who are mildly or moderately dehydrated . This approach will minimize the use of IV fluids , as patients can self-monitor and administer their fluids with ease and safety at home or within other caring environments .”
( Lawrence , et al ., 2020 ). Applying the acute care model , which is also called the congestive care model , hospitals try to spare more resources for the clinical areas where patients need treatment most of all while postponing treatments that are not vital for the patient ’ s life .
Alternative Measures to Address the Shortage
To overcome the issue of saline solution deficiency , physicians have been persuasive in prescribing oral rehydration solutions to patients who are mildly or moderately dehydrated . This approach will minimize the use of IV fluids , as patients can self-monitor and administer their fluids with ease and safety at home or within other caring environments . Furthermore , in place of saline , hospitals are using other fluids , including lactated Ringer ’ s solution or dextrose in sodium chloride solution , and these alternatives are customized depending on the patient and the clinical circumstances ( Hirschmann , et al ., 2020 ). This flexibility goes a long way in reducing some of the pressure on saline supply while at the same time supplying patients with necessary fluids .
The other strategy includes the use of saline locks , which introduce a saline-filled tube into a peripheral vein but do not continuously infuse the fluids . It uses less saline and permits on-and-off dosing for bacterial exposure to the antibiotic . Also , where possible , converting from IV medications to oral forms reduces the use of saline solutions and enhances the efficient use of available resources ( Shukar , et al ., 2021 ). This is where the interdisciplinary work is essential ; better coordination of caregivers and healthcare workers in general is useful for clinical appraisal of the needs of
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