Baxter International Facility Sustains Critical Damage From Hurricane Helene

Statement from Baxter International:

As we have previously shared, Baxter International’s manufacturing facility located in Marion, NC sustained critical damage from Hurricane Helene and is currently closed for production. As Baxter supplies approximately 60% of IV solutions used in North America, DUHS and hospitals across the U.S. are anticipating significant shortages of Baxter IV fluids.

Clinical and administrative leaders across the health system are working to develop a comprehensive conservation strategy. In an effort to ensure the continuity of patient care is maintained, we have consolidated our inventory of IV fluid for normal saline and lactated ringers to a central distribution point.

Important Points to Note for Duke University Hospital:

• If a patient is hemodynamically decompensating and there is a clinical emergency (including sepsis), proceed as you would normally do in ordering IV fluids to resuscitate the patient. The IV fluid supply will come from your clinical units’ supply and be replenished by restocking from the central distribution room. When a patient has stabilized, please follow previously distributed guidelines on appropriate use of IV fluids.
• If a patient does not have a clinical emergency and you are considering ordering IV fluids (bolus or continuous infusion) then you must contact your responsible covering attending for approval of that fluid order and this approval must be documented in a progress note. There will be an auditing process to confirm compliance with this process.
• Every team must review daily (starting today) their list of ongoing continuous IV fluids to confirm clinical need. We highly encourage all clinicians to add IV Fluids column to their patient lists.
• To order IV fluids, call the Fluid Distribution Center at 919-681-6851. Once confirmed, the fluids will be delivered to you.

As a reminder, the following clinical practices should be implemented immediately:

Maintenance Fluid

• When appropriate, limit maintenance fluids to a specific total volume or time frame.
• Consider oral hydration strategies when possible. We are increasing availability of electrolyte PO fluids in partnership with Food Services (ex. Gatorade and Pedialyte).
• Frequently review and consider elimination of continuous intravenous fluids (IVFs) for patients who are not NPO (or able to take an oral diet).

Procedural/OR

• Consider opportunities to reduce sterile fluid use (intravenous and irrigation) in procedural cases when appropriate.

Nursing Processes

• Extend use of IV and flush bags from 24 to 96 hours when changing tubing.
• Use small-volume bags for low infusion rates.
  • Do not use 1L bags when a 100ml bag will do.
  • Prime A lines with 500mL bags instead of 1L bags, changed every 4 days
• Eliminate use of Keep Vein Open (KVO) protocols.
• Limit quantities of IV bags placed in warmers to avoid early expiration.
• Verify ongoing fluid needs with providers before a new IV fluid bag is spiked.
• Finish IV bags from the OR or procedure area when going to unit from surgery rather than switching over to a new bag immediately.

Clinical Practice

• Do not empirically start IVF unless clear indications.

Our incident command center remains active and available to assist with any needs. Hours are from 7 a.m. – 7 p.m. To contact the command center, call 919- 684-2222.

We will continue to provide updates as conditions unfold. Our Supply Chain colleagues are working diligently to ensure we are able continue providing quality care to those who need us. Thank you all for your partnership and collaboration, and for your dedication to provide remarkable care to our patients, their loved ones, and each other.