National Shortage of Normal Saline for Injection: What’s Next?

As pharmacists, we all have been impacted one way or another by drug shortages. Approximately 230 medications are currently identified by the American Society of Health-System Pharmacists in short supply.¹ Of those medications, many are required to be added to a diluent solution for IV administration. Although as pharmacists we create strategies to optimize pharmaceutical care on a daily basis, sometimes a shortage may arise that requires a more creative plan. This shortage is normal saline for injection. Shortage of normal saline for injection is currently in volumes including 100, 250, 500, and 1000 mL from companies including Baxter, B. Braun, and Hospira.² The reason for the shortages has been the increased demand for all products. Also, future availability of all normal saline injection products is not guaranteed, thus continuing to complicate patient care.

This shortage has significant implications for patient care including patients receiving dialysis, changing or adjusting protocols for drug delivery, compatibility of drug solutions for infusion, potential increase in patient electrolyte monitoring, the need for more frequent IV bag changes, and educating the nursing and medical staff about prescribing diluent solutions. In addition, potential medication errors can occur if concentrated sodium chloride solutions are needed for compounding traditional sodium chloride solutions.

I believe many of us as healthcare providers take for granted the availability of diluent solution including normal saline, 1/2 normal saline and 5% dextrose and water. I believe these formulations will continually experience peaks and valleys of availability. However, in the future, if these solutions were to be discontinued or unavailable for longer periods of time, pharmacists will then have to rely on traditional compounding methods to create these formulations. Based upon the large amount of IV solutions used in some institutions, significant time may be needed to compound these solutions. Time may include the need to have pharmacists/technicians compounding these solutions during the overnight hours to accommodate the needs for the following day.       

What strategies have you implemented during the normal saline shortage? I welcome thoughts and ideas to share with other members of the PLN network.

Michael J. Cawley, PharmD, RRT, CPFT, is a Professor of Clinical Pharmacy at the Philadelphia College of Pharmacy, University of the Sciences. He has greater than 25 years of experience practicing in the areas of medical, surgical, trauma, and burn intensive care as both a critical care clinical pharmacist and registered respiratory therapist.

 References:

1. American Society of Health-System Pharmacists. Drug Shortages Bulletin. https://www.ashp.org/menu/DrugShortages/CurrentShortages. Accessed January 19, 2014.

2. U.S. Food and Drug Administration. Drug Shortages. https://www.fda.gov/Drugs/DrugSafety/DrugShortages/ucm314743.htm#sodiumch. Accessed January 19, 2014.