Puerto Rican maker of IV bags sidelined; Hub hospitals run low

Local hospitals are “critically low” on supplies used to administer antibiotics and hydrate the sick, after Hurricane Maria jeopardized production in Puerto Rico.

“We are running critically low on mini-bags, used to dilute drugs like antibiotics so they can be dripped slowly into patients’ veins,” said Dr. Paul Biddinger of Massachusetts General Hospital’s emergency department. “Hopefully we’ll be as judicious as we can, but there is no easy fix.”

Baxter International is the primary resource for these small IV bags out of its Puerto Rico location, Biddinger said, and the shortage is now seen in hospitals nationwide. As of a week ago, MGH saw a shortage of larger bags that hydrate patients with saline solution. Patients can still be treated sufficiently, but the burden falls on hospital staff, such as nurses who are charged with manually diluting antibiotics or administering them very slowly to refrain from dipping into the mini-bag supply — a technique known as an “IV push.”

“We have to work around it,” Biddinger said. “We are saving them for those uses for which there is no other alternative.”

The dearth of hydrating bags is trickier to manage, and the problem was compounded by a shortage after Pennsylvania-based manufacturer B. Braun faced production issues starting about 18 months ago.

Boston hospitals dodged the initial effects, but Hurricane Maria has left no facility untouched. Brigham and Women’s Hospital and Tufts Medical Center have seen the same low numbers of supplies.

“I don’t know that you’ll be able to talk to a hospital that hasn’t been affected,” said Ross Thompson, executive director of pharmacy at Tufts.

Baxter, based in Illinois, said the Food and Drug Administration gave the OK to import supplies from its locations in Ireland and Australia.

But local hospitals do not foresee the supply increasing for at least six months.

“We don’t have any clarity around how long we’ll be in this state,” Thompson said.

Alternatives include ordering pre-mixed antibiotics, but that could bump up the cost of care, Thompson said.

The issue is just a close-tohome reminder of the importance of helping Puerto Rico get back on its feet, doctors said. “I had no idea the extent of the product we received from Puerto Rico,” Thompson said. “If nothing else, it’s been a huge wakeup call.”