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The Impact of Nationwide IV Fluid Shortages
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Released: October 22, 2024

Expiration: October 21, 2025

John Marshall
John Marshall, MD

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MedBuzz: How Are You Managing The IV Fluid Crisis?

[00:00:05] John Marshall, MD: Hey, everybody. John Marshall for Oncology Unscripted with Dr. John Marshall. There is so much going on in the unscripted world today, that we better jump right in.

And I know if your site is like my site, then you're having issues with IV fluids. This is all the gossip and business news of the week with every hospital system. Not every hospital system, 60 percent of the United States gets IV fluids from one plant in North Carolina. The Baxter plant there, and they have had a very, very hard time. So, we have to be, of course, forgiving about that and understanding, but we'll come back to the issue of why 60 percent of our supply comes from one plant in the United States in Western North Carolina.

[00:01:01] let's talk about the impact of this. on all of us today. So, if you are one of those health care systems where you got your IV fluids from Baxter, if your team's like our team, we are trying to figure out sort of like it was during the pandemic, how do we stay open? How do we continue to deliver the care that we deliver for our patients, not knowing when we're going to run out of our current supply of IV fluids, and I know with every system out there, at least I think with everyone I've talked to so far, there's sort of a two pronged attack of how can we conserve. What are we giving now that is just our old training of internal medicine of surgery of whatever disease we focus on. That training of what we give for fluids and how much fluids we give, how much of that is still okay, and the right thing to be doing. And how much of it could we actually not do? You know, we think about hydration around chemotherapy in our world. Well, how much could we, in fact, change from cis to carbo. Cis needs a lot of IV fluids. Carbo doesn't really need any. There's certain diseases, maybe head neck, certainly testicular cancers, where cis is the right answer. I think it's been asked and answered. But there are a lot of other cancers where maybe carbo is the same.

[00:02:28] I take care of GI cancers, for example, and in cholangiocarcinoma the regimen is gem/cis. Can I switch to gem/carbo? I don't know. Would the insurance company cover it if I switched to gem/carbo? Yeah, there's some cost savings on one side, but I don't really have data that gem/carbo is the same as gem/cis in cholangiocarcinoma. So I got to make a decision on the fly. I've got interest in trying to manage this for the time ahead, but I've also got to try and optimize my patient's care.

[00:03:03] Can I flip IV antiemetics to oral antiemetics? Probably will work pretty well, but what if a patient has a bad cycle on their oral antiemetics? They're going to blame the change from IV to oral, right? And if I change, do I have to go back and re-preauthorize? You know what a lovely job that is to get preauthorization for everything you do. So, if your center's like mine, then you're spending a lot of your day, trying to do the best you can to keep the shop open and offering all the care that we give to patients across the board and your cancer business, so that you can make sure you deliver the best patient care you can while at the same time trying to conserve.

[00:03:50] And just like with the pandemic, I think about tele visits, for example, we didn't really do those before the pandemic. And now we do a lot of them. What changes are going to happen? What SOPs are going to change as a result of this fluid crisis? We'll see, and maybe we'll report on it on Oncology Unscripted sometime in the future when that plant goes back online.

[00:04:14] But let's, let's talk a little bit about that plant. So, you know, it's a lovely part of the country. I can understand why you'd build a nice plant there, but then why would so many of us, over half of us across the country, get all of our product from that one plant? It really speaks to the sort of supply chain issue, that's out there, and that we'd be so vulnerable as a health care system to rely on just one building and one group of people to provide us with such a critical need. And so, maybe this will spark a sort of look into that.

[00:04:49] But we encounter this and other places, right? There's like one plant that makes, leucovorin and so when they had trouble making leucovorin for a while, what did we do? Well, we partly decided we didn't care. We don't really need leucovorin that much. Or we went to Costco and got oral folic acid. By the way, that'll work to replace the fancy leucovorin that we give patients with our 5-FU or for rescuing from methotrexate. Actually, folic acid won't really rescue the methotrexate, so don't try that at home. But you get the idea. We made changes.

[00:05:24] We've had other drugs. There are other examples where there's really one plant that makes that particular medicine. And when it has trouble, then what do we do? We don't have access to that particular medicine. So, it's not a new problem for us, but I don't think we've ever seen the kind of impact that we're seeing now, from this one plant, the Baxter plant in North Carolina. So hopefully we will make it through, and hopefully we will have learned some critical lessons that will improve our efficiency while maintaining our excellent standards of care.

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This transcript has been lightly edited for clarity.