A shortage of IV bags linked to hurricane damage in Puerto Rico has left hospitals across the nation, including in Alaska, scrambling over the past several months to find alternative ways to administer certain medicine.
"We use these bags ubiquitously across the hospital," said Andre Neptune, director of pharmacy at Providence Alaska Medical Center in Anchorage.
The availability of those IV bags — used to deliver medicine and treat dehydrated patients — has plummeted since Hurricane Maria slammed Puerto Rico in September. The hurricane cut power to Baxter International's factories on the island, which make much of the U.S. supply of the fluid-filled bags.
Providence, the state's largest hospital, usually purchases IV bags from Baxter. So do other Alaska hospitals, including Alaska Regional Hospital in Anchorage and the Mat-Su Regional Medical Center in Palmer.
The bags come in different sizes and contain saline solution when shipped. Other bags are premixed with commonly used antibiotics.
"They're used for multiple purposes every day, on almost every type of patient," said Timothy Dey, director of pharmacy at Alaska Regional.
Dey, Neptune and James Bunch, the director of pharmacy at the Mat-Su Regional Medical Center, said the worst shortage has been for small saline bags, used to dilute antibiotics and hydrate patients. The bags hang from a pole and the mix drips through a tube and into a patient's vein.
They said that the shortage has not affected patient care at their hospitals, but it has created a significant logistical challenge for staff.
At Providence, Neptune said, the pharmacy's operations team holds a "full-court press" every day looking at the shortages and devising workarounds. At the hospital's morning safety meeting, the pharmacy team alerts staff of the latest modifications to deliver certain drugs.
For instance, Neptune said, Providence would typically dilute certain antibiotics in a saline IV bag before delivering it to a patient. When the hospital couldn't get the saline bags, it may have ordered premixed bags. When those became unavailable, it may have used a syringe.
"We've had to change the way we deliver medicines and the way we provide care, but the quality of care remains unchanged," he said.
At Alaska Regional, nurses are delivering more medications using IV syringes, known as an IV push, because of the lack of small IV bags, Dey said. The hospital is using the larger IV bags it has to dilute medications.
Baxter is also sending Alaska Regional, as well as Providence, roughly 20 percent of the hospital's usual order.
"In addition to that, we've just been basically scrounging the market," Dey said.
The Associated Press reported that only a few other companies make the IV solutions. Supplies of saline bags never fully recovered after a shortage in 2014.
Bunch said the Mat-Su Regional Medical Center started rationing its supplies earlier this year after Baxter warned that an incoming hurricane could impact production.
"We knew we were going to have a problem," he said.
Nurses started to administer drugs using a syringe when possible, he said.
He said the hospital received a shipment of a small IV bags last week that had long been on backorder. But, he said, supply is in no way back to normal.
Bunch, Dey and Neptune said they are hopeful for relief from the shortage later this year.
On Thursday, the Food and Drug Administration said production at Puerto Rico plants remained fragile, the Wall Street Journal reported.
Baxter told the newspaper that the company's two IV plants were hooked up to the electrical grid, but power was "intermittent." The company said it expected "to return to more normal supply levels for products made in Puerto Rico in the coming weeks."