Shortages of I.V. normal saline in liter bags continue with no end in sight. Manufacturers are still using allocation processes to determine which facility receives a designated amount of saline solution, typically an amount less than what would normally be ordered. The problem is also affecting compounding pharmacies in all communities and their ability to provide IV medications for alternative settings.
The majority of the problem is falling to pharmacists to chase whatever saline solutions might be available on a daily basis. Additionally prescribers have been asked to alter the solutions being given to patients. For example, 0.45 % sodium chloride or 5% dextrose/0.45% sodium chloride could be substituted for 0.9% sodium chloride. The FDA anticipates that the shortage will end in early 2015 but many experts have their doubts. To read a recent report, click here .
What do these shortages mean for your practice? Has it changed the way you deliver IV medications? My concern is the use of bags of normal saline as the carrier fluid for piggybacking IV medications.
Most hospitals now require infusion pumps for delivery of all fluids including piggybacked medications. The Infusion Nursing Standards of Practice recommends backpriming so that the secondary piggyback set can remain connected to the primary continuous infusion set. This practice reduces manipulation of the IV sets and reduces the contamination and risk for CLABSI. Normal saline is used as the “carrier” fluid if the primary continuous fluid has medication added to it that could be incompatible with the secondary medication.
When the continuous fluid is no longer required and the intermittent medication is to continue, the infusion pump is still used to regulate the medication flow rate. This leaves a significant amount of medication in the infusion pump set that needs to reach the patient, so again saline is required.
Has your hospital found a way to eliminate the need for this saline as a carrier fluid? Does your facility still require the infusion of I.V. medications be controlled by an infusion pump? Infusion by gravity would mean that much less fluid is left in the IV set and eliminate the need for the saline to flush the IV set – this was common practice about 15 to 20 years ago. But gravity infusion means an increase in nursing time to count drops and regulate infusion rates – a practice that many nurses have never learned.
What other infusion practices have changed due to the saline shortages? We encourage you to share your ideas about dealing with this saline shortage.
Author: Lynn Hadaway
Lynn Hadaway has more than 35 years experience in infusion nursing and adult education. Her experience comes from multiple acute care settings, healthcare manufacturing, continuing professional education.