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When Hurricane Helene struck North Carolina in September 2024, the nation’s supply of vital intravenous (IV) fluids was severely disrupted. A manufacturing facility owned by Baxter

International took a massive hit and experienced major flooding. This single plant had been responsible for producing around 60 percent of this country’s IV fluids, including those used at

Dole VA. Since IV fluids are essential in modern health care and are used for treating dehydration, supporting surgeries, and delivering medications intravenously, this sudden interruption

in the supply chain had a significant impact on the ability of VA medical centers to treat patients in emergency and critical care situations. Dr. Anna Johnson, PharmD, is the Dole VA

pharmacy procurement program manager. She said the damage to the area was so intense, access to the Baxter plant in the mountains of North Carolina was reduced to a single footbridge. “The

factory shut down and began rationing its remaining products, so we immediately had to assess our stock on hand and the burn rate of our existing supplies to see how long they could last,”

Dr. Johnson said. “We had to completely rethink how we use and conserve this valuable commodity.” Dr. Johnson and her team, which includes certified pharmacy technicians Brian Long and Amber

Jones, flagged the major drug bags of concern that would likely deplete fastest. They then worked closely with clinical chiefs, surgeons, and nursing teams to brainstorm ideas for making

the IV supplies last as long as possible. Running out of IV fluids could have led to restrictions on hydration IV fluids for Veterans being treated on our inpatient floors, surgery/procedure

cancelations, or prioritizing surgery procedure needs. Yet, despite the supply chain pressures and the need to stretch supplies as far as possible, Dr. Johnson said there have been zero

cases of Veterans not receiving the care they needed. “We are very proud of the fact that we have not had to cancel or reschedule any procedure, admission, or any health care because of the

IV fluid shortage,” she said. "That's the result of the how we have handled this situation. Everyone works hard serving our Veterans, and we continue to do so.” Chief of Pharmacy

Services Dr. Scott Hood stressed the IV fluid shortage is still in effect and will last for at least a few more months. “While our pharmacy staff and medical center has done a great job

conserving and managing our IV fluids through this shortage, we still need everyone to remain diligent," Dr. Hood said. "The shortage is not over, and it will continue well into

the new year."  An area of concern has been the three-liter normal saline irrigation bags used during surgical procedures.  Dr. Hood said without allocation from Baxter, Dole VA

continues to deplete our supply.  “To offset this, pharmacy has purchased a repeater pump that can be used to repackage our smaller IV bags into larger sizes,” he said. “Working with

surgery, we can estimate the needed three-liter normal saline bags and compound patient specific ones. This should slow our depletions.