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Managing Cancer Treatment Amid a Nationwide IV Fluid Shortage
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Key Takeaways
- Hurricane Helene caused significant IV fluid shortages, affecting cancer patients reliant on these for chemotherapy toxicity management.
- Hospitals face up to a 50% reduction in IV supplies, leading to elective surgery cancellations and alternative hydration strategies.
The closure of Baxter’s North Cove facility has significantly impacted existing IV fluid shortages into 2025.
In 2024, Hurricane Helene devastated much of North Carolina and the southeast coast of the United States, damaging and forcing major IV manufacturing facilities to close. Despite the FDA’s efforts to increase supply at the end of the year, shortages are projected to persist in 2025. This may have significant consequences for patients with cancer who rely on IV fluids to prevent the toxicities of chemotherapy and manage adverse effects (AE) of treatment.1
Nurse preparing dextrose infusion | Image Credit: © Sherry Young - stock.adobe.com
The IV fluid shortage has created challenges across medical institutions, with many hospitals seeing as much as a 50% reduction in available products or supplies. The FDA has reported shortages of saline and sterile water solutions on and off since 2021, but the hurricane has greatly exacerbated limited supply. Dextrose containing solutions have also been in short supply since early 2022 and 2023.1
According to a survey conducted by Premier Inc on October 7th and 8th to evaluate IV fluid supplies, over 86% of health care professionals reported shortages. Across the 228 centers in the evaluation, 54% of respondents reported having 10 days or less of IV fluids. The survey also found that the shortages led to the cancellation of elective surgeries to preserve remaining supply.1,2
The Baxter North Cove, North Carolina facility, which was forced to close, produced approximately 60% of the country’s supply of IV fluids and dialysate solutions. As of December 19, 2024, the company reported that they have restored 8 of the 10 manufacturing lines, representing about 85% of the facility’s capacity before the hurricane. Baxter is expected to release another update in the first quarter of 2025.1-4
“While remarkable progress has been made in reactivating Baxter's plant operations, hospitals are still receiving less than their normal required amounts of these fluids,” said Nancy Foster, vice president of quality and safety policy at the American Hospital Association, in an article MedPage Today. “We know some hospitals are still restricting access to elective surgeries, and most are using alternative strategies for hydrating patients when possible and utilizing smaller bags of fluids when appropriate."3
IV fluid shortages hold significant consequences for patients, and certain populations may require more immediate access to these products. Critically ill patients, such as those with cancer, often require IV fluids to mitigate chemotherapy-related toxicities and AEs. For example, continuous IV fluids are commonly used for renal protection when administering agents like cisplatin (Platinol; Bristol Myers Squibb), and for preventing hemorrhagic cystitis in patients receiving cyclophosphamide (Cytoxan; Amneal Pharmaceuticals) or ifosfamide (Ifex; Baxter). Oncologic emergencies, such as hypercalcemia, also rely on aggressive hydration as an initial intervention, with guidelines often recommending fluid volumes of up to 3000 mL/m² per day.1
Nausea and vomiting are the most common treatment-related AEs, which frequently necessitate IV support in inpatient and outpatient settings. Continuous IV support is also needed for patients receiving bone marrow transplants to prevent complications from chemotherapy, maintain intravascular stability, and provide nutritional support when nausea impairs eating habits.1
The current IV fluid shortage has been challenging for health care teams but highlights opportunities to improve resource management and reduce waste. By better identifying which oncology patients need continuous or "keep vein open" fluids and increasing the use of IV push or oral medications, facilities can optimize fluid use. Additionally, extended expiration dates approved by the FDA for products such as 5% dextrose in water, sterile water, and Ringer's lactate solution may further minimize waste. The American Society of Health-System Pharmacists predicts the shortage may last several months and advocates for measures like diversifying suppliers, establishing importation plans, and creating prioritization guidelines to stabilize supply chains.1
As of January 8, 2025, the FDA has reported the following products as currently in shortage and potentially impacted by the North Cove facility closure:5
- Dextrose 5% IV Solution
- Dextrose 10% IV Solution
- Dextrose 70% IV Solution
- Lactated Ringers IV Solution
- Peritoneal Dialysis Solution
- Sodium Chloride 0.9% IV Solution
- Sodium Chloride 0.9% for Irrigation
- Sterile Water for Injection
- Sterile Water for Irrigation
Additionally, the agency added empty IV bags to the Medical Device Shortage list in December 2024, which is estimated to last through March of 2025. The shortage includes bags of all sizes due to increased demand.6
The ongoing IV fluid shortage underscores the importance of proactive measures to secure pharmaceutical supply chains and safeguard patient care during crises. Continued collaboration among health care facilities, government agencies, and manufacturers will be critical in navigating these challenges.
