ASA Suggested Actions on Conservation of IV Solutions During Ongoing Shortage

ASA is actively monitoring the supply chain effects of the temporary shutdown of the Baxter North Cove manufacturing site that is critical to the U.S. supply of IV solutions. ASA will continue to provide updates to members from Baxter and federal agencies on the status of IV solution allocation and availability.

This guidance conveys suggested actions members and their facilities can consider to conserve IV solution supply without compromising patient safety or quality of care. Broadly, anesthesiologists’ clinical judgment on individual cases should supersede these suggested actions. We recognize individual facilities likely have more detailed recommendations and protocols.

Anesthesiologists should engage with patients, as necessary, to assuage any safety or care concerns a patient may have related to IV fluid conservation efforts.

Suggested Actions

• All appropriate* preoperative and preprocedural patients should be encouraged to consume clear liquids until two (2) hours before the anesthesia or sedation start time. Clear liquids include those containing carbohydrates, black coffee, black tea, and juice without pulp. This practice is in accordance with the ASA Practice Guideline on Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration. This instruction helps ensure patients are hydrated and decreases the need for IV fluids.
• *Note: This practice should be individualized when concerns of elevated aspiration risk exist.
• When considering recommendations on consuming liquids for patients in labor, anesthesiologists and other relevant staff should consult ASA’s Statement on Oral Intake During Labor.
• Postoperative staff may prioritize oral hydration of patients after surgery as appropriate to lower reliance on IV fluids.
• Anesthesiologists and other qualified personnel may consider different methods to manage or limit the amount of IV fluids used during a case, when clinically appropriate.
• Microbore IV tubing and/or mini-drip fluid administration sets may prevent the accidental administration of larger volumes of fluid.
• Saline locks, including heplocks, may be used for some minor procedures to administer medications with compatible fluid flush instead of continuous fluid administration.  Anesthesiologists and their departments should determine which procedures and episodes of patient care can safely and effectively incorporate saline locks, such as upper GI endoscopy and cataract surgery.
• Anesthesia departments should collaborate with their institution’s pharmacy to consider purchasing pre-filled syringes or compounded alternatives to medications that are usually administered in IV fluid bags or diluted into an IV fluid bag (e.g., vasopressors).
• Anesthesiologists and other qualified personnel may dilute antibiotics in syringes rather than IV bags when clinically applicable.
• Any use of syringes to dilute antibiotics should follow manufacturer instructions, including but not limited to dilution fluid, concentration, and speed of administration.
• Anesthesiologists should work with trauma personnel to determine the appropriate set-up of pre-spiked IV bags to facilitate trauma workflow needs and limited time for preparation. The use of pre-spiked fluid bags should be limited in non-emergency areas to limit IV fluid waste.