Patients are having to stay in hospital care units after surgery for longer, as doctors are forced to ration IV fluids amid a worldwide shortage.
An internal email sent at one major Sydney hospital on Wednesday night, obtained by the ABC, tells staff there had been instances of patients who had “little or no” IV fluid administered during an operation having to stay in the recovery unit for longer because of hypotension and dehydration.
Doctors are also warning the critical IV fluid shortage could impact some elective surgeries, and say they have been “left in the dark” over the extent of shortages.
Pressure is mounting on federal health authorities to do more to guarantee supply of the lifesaving essential medicine, as the health system grapples with the impact of a worldwide acute shortfall of products like saline and sodium lactate solution.
IV fluids are a critical medicine used across the sector, from treating sepsis and dehydration to helping patients in intensive and post-operative care.
The Australian and New Zealand College of Anaesthetists (ANZCA) president David Story accused health authorities of providing “inadequate information” about the extent of the shortage and what to expect in the future.
“We’re being left in the dark as to what is happening about the fluid situation across the country,” he said.
“We are concerned that if there is a continued decrease in supply, elective surgery may be cancelled.
“There needs to be much greater transparency of what’s happening at individual states, but to a certain degree, individual hospitals, and there need to be honest discussions about where places may need to cease elective surgery if required.”
An email sent to doctors in one NSW health district late last month directed them to use “conservation strategies” to manage the shortage, including restricting some solutions for use in resuscitation, intensive care and surgery, minimising fasting in surgical patients to reduce the need for fluid replacement and using oral fluids wherever possible.
NSW Health has been contacted for comment.
Australian Medical Association (AMA) president and clinician Steve Robson said the shortage was significantly impacting his work.
“With my own surgical list that I’ve just finished this morning we had major problems sourcing appropriate intravenous fluids,” he said.
“I have personal experience at this, and I believe it’s playing out in hospitals and clinics around the country.”
He also warned elective surgeries could be affected.
“Some use an enormous amount of intravenous and other fluids, it may well be that if these supplies can’t be guaranteed – within days in some settings – there will have to be cancellations of planned surgery.”
One senior clinician in a major Sydney hospital, who did not want to be named because he is not authorised to speak publicly, said the shortages were extremely frustrating.
“Lots of cases which would normally receive fluids are not getting them, we’re having to ration things,” he said.
“Restricting fluid practices for things like abdominal surgery can increase the rate of renal failure and infection, so it’s important we are able to use fluids judiciously according to the clinical need of the patient.”
The federal government said it had not been notified of any interruption to surgical activity.
‘No clear plan’ to handle shortage, warns former top doctor
Higher-than-expected demand and manufacturing constraints have fuelled the global supply shortages.
As a temporary solution, the Therapeutic Goods Administration (TGA) has approved overseas-registered alternative saline brands.
But former deputy chief medical officer and Australian Patients Association (APA) ambassador Nick Coatsworth asked why Australian manufacturers were unable to help plug the gap.
“A lot of people will be questioning why it’s so hard to make salt water – and I am too,” Dr Coatsworth said.
“It is one of the more straightforward things to produce.”
Health minister Mark Butler has convened an urgent response group to look at the shortage, comprised of the states and territories and various health stakeholders.
“The TGA has approved a number of alternative supplies from overseas to supplement the local production, which is managing to get us through this period of higher demand,” he said.
“The government is working with states and territories, and with private hospitals, to minimise any impact on patient care.”
Shadow health minister Anne Ruston accused the government of dragging its feet.
“What actually is the government doing? We’ve known for over a month now that there was a shortage of IV fluids in this country, and it took the minister until Friday to put together a monitoring group,” she said.
“We need actions. We don’t need just a monitoring group. We actually need action to make sure that we have a supply of this really important emergency product for our healthcare system.”
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