Member Alert: IV Fluids Shortage

15 Nov 2024

Update 15 November

The AVA remains engaged in ongoing discussions at a national level, including with human health sectors, to support the veterinary profession during the IV fluid shortage. We continue to advocate for veterinarians, ensuring that the challenges are heard.

The AVA attended another National Response Group - IV Fluids meeting this week, where a conservation message for the remainder of 2024 and into the start of 2025 was relayed. The damage from Hurricane Helene in the United States means that the supply of IV fluids will remain constrained into 2025. The Therapeutic Goods Administration (TGA) have updated information on their website. There was also advocacy to increase local (Australian) production levels.

Given the likelihood of ongoing shortages into early 2025, conservation efforts remain essential. The AVA advises veterinarians to consider preparing for the summer period by revisiting fluid protocols in anticipation of continued constraints.

AVA resources to assist veterinarians include:  

The veterinary profession’s efforts in managing these shortages are acknowledged and greatly appreciated, and we will continue to keep you updated on any new developments.

Background

The National Response Group for the management of the Intravenous Fluid shortage was formed at the request of the Victorian Department of Health Secretary, Professor Euan Wallace and chaired by Professor Andrew Wilson, the Chief Medical Officer in the Victorian Department of Health.

This group includes representatives with executive oversight and procurement leaders from all Australian jurisdictions, clinicians in both the public and private hospital sectors, alongside representatives from community health care and day procedure centre providers, ambulance providers, veterinary practice representatives from the Australian Veterinary Association, the Therapeutic Goods Administration, the Australian Medical Association, the Australian and New Zealand College of Anaesthetists, Advanced Pharmacy Australia and the Commonwealth Government, with engagement and updates from industry representatives.  

The National Response Group will continue to monitor the situation, provide responsive information to the health sector and will continue to work alongside key stakeholders to ensure supply and demand are adequately and appropriately managed.  

 

Update 1 November

In light of the recent IV fluid shortages, an Australian supplier has obtained an APVMA Emergency Permit for IV fluid products sourced from overseas. Approval required rigorous testing of the products in an independent, accredited Australian laboratory. These fluids, which are imminently available to the Australian veterinary community, will help provide a reliable alternative to bolster ongoing supply challenges and ensure quality care for patients.

The AVA will continue to advocate for veterinary access to IV fluid supplies and provide updates on the shortage as they become available.

 

Update 25 October

The findings of the AVA IV Fluid Shortage Impact Survey recently undertaken reveal the significant effects of the shortage on veterinary practices nationwide. With 89% of respondents experiencing disruptions and over 65% reporting compromised patient care, the data underscores the critical nature of the issue. The report includes some strategies clinics have implemented to manage the shortage and outlines the AVA's ongoing advocacy efforts to secure greater access to IV fluids. The full report can be found here.

 

Update 18 October

On 14 October the AVA attended another meeting of the National IV Fluid Response Group. 

Led by the Victorian Chief Medical Officer, the group was formed to collaboratively address IV fluid supply issues across Australia. The group includes representatives from state and territory health departments, private hospitals, the Commonwealth, the Australian Medical Association (AMA), the Australian and New Zealand College of Anaesthetists (ANZCA) and the Australian Veterinary Association (AVA). The group meets weekly to coordinate a national response to IV fluid shortages.

The group reports that the national shortage of intravenous (IV) fluid bags across multiple suppliers is ongoing and anticipated to continue for the remainder of 2024 and recommends that judicious conservation of all fluids should continue. There has been damage to a production facility in the US due to recent hurricanes, it is not confirmed if this will delay the arrival of stock into Australia and the planned rebuild of stock.

The AVA will continue to represent the veterinary profession at this national forum, and advocate for increased veterinary access to supplies. The AVA advises continuing conservative or judicial use until supply becomes more secure. 

 
AVA resources to assist veterinarians:    
•    a document provided by the Executive of the ANZCVS Veterinary Anaesthesia & Analgesia Chapter to assist with managing the IV Fluid shortage,    
•    material that can be used for client communication,  and    
•    AVA guidance for unregistered/off label use.   

 

Update 11 October

As noted below, the AVA survey on the impact of IV fluid shortages has provided essential data to help advocate for the veterinary profession at the Federal level. The AVA advises continuing conservative or judicial use until supply becomes more secure.

The survey results highlight that fluid supply is an ongoing challenge impacting practices at varying levels depending on their ability to source or conserve fluids. The feedback underscores the need for the AVA to provide continued advocacy, practical guidance, and long-term solutions to address the vulnerability of Australia's veterinary supply chains.

AVA resources to assist veterinarians:  

Below is a summary of responses from members. The survey remains open until Monday 14 October.

IV Fluids Impact survey response

As of October 11, 143 AVA members have responded to the survey regarding the IV fluids shortage, shedding light on the diverse impacts across veterinary practices. An overwhelming majority (89%) reported being affected by the shortage, with the consequences ranging from patient care concerns to business disruptions. Over 65% of respondents indicated that the shortage has changed the standard of care they can provide, and 50% acknowledged it has also impacted their business.

The length of time respondents expect their supplies to last varies significantly, highlighting the urgency of the situation for some and less immediate concern for others. Some practices report being out of stock or having only days of supply left, while others estimate they can manage for several months. Here are a few examples:

  • "We are in a crisis." (out of stock)
  • "A few weeks at best."
  • "We have a few months of supply remaining."
  • "Currently rationing usage, could last until January 2025."
  • "We stocked up in advance and should be fine for 4 months."

Conservation efforts vary, with some practices using compounded fluids or deferring elective procedures, while others have secured new suppliers or are relying on stockpiling. The emotional and operational toll is evident, with many expressing frustration at the lack of local manufacturing and the disparity between the veterinary and human health sectors.

A selection of verbatim comments that capture the range of feedback:

"We had horses die from septic shock due to compounded fluids contamination - we needed more help with techniques to make compounded fluids in order to keep horses alive. Unfortunately, errors were fatal."

"We need to manufacture IV fluids in Australia. This is a huge vulnerability that is disrupting animal and human healthcare."

"Our clinic sees over 250 snake bites per season. We've had 5 so far and only have 20L of fluids left. We are not going to be able to save many more snake bite victims."

"This can be seen as a learning exercise & should encourage us to fund local suppliers to produce very simple products like IV fluids."

"The AVA has been very vocal, but I don't feel that they have actually achieved anything to help funnel some fluids from the human health space to the veterinary space."

"Thanks for helping provide guidance to vets around the fluid shortage – I think the AVA communication has been great!"

 

Update 4 October

Earlier this week, Sally Colgan attended a meeting of the National Response (IV Fluids) Working Group (NRWG) which includes key stakeholders from the human health sector and now includes the AVA. At this meeting, we provided an update on the current situation and emphasised the ongoing impact of the fluid shortage on the veterinary sector. The Response Group is actively monitoring supply and demand challenges and coordinating the national response to the IV fluid shortage across both human health and veterinary sectors. The group continues to stress the importance of conserving fluids of all pack sizes across all sectors.  

The AVA values its involvement in this group, where we advocate for improved access and supply for the veterinary profession. 

 The AVA survey on IV fluid shortage impact has provided essential data to help advocate for the veterinary profession at this level. The data enables the AVA to provide stronger representation to secure access to fluids. We appreciate the high level of engagement from members and the survey will remain open until 14 October. Given the evolving nature of the situation, we encourage you to keep us informed about how your practice is managing the shortage, allowing us to continue raising these concerns at a national level on your behalf. 

So far, survey responses reveal significant challenges across veterinary practices. The majority of respondents (88%) report being impacted by the shortage, and nearly 80% are aware of colleagues facing similar issues. At this stage, small animal practices make up the largest group of respondents, followed by mixed and equine practices, with some being part of larger veterinary groups

The data shows that many practices have been forced to adopt conservation measures, such as deferring elective surgeries, reducing the use of IV fluids, and relying on compounded fluids to cope with dwindling supplies. Over two-thirds of respondents (67%) indicated that the shortage has affected the standard of care for their patients, with clinics struggling to provide adequate fluid therapy, particularly in cases like snake bites and equine care, where large fluid volumes are required. While 50% of respondents noted an impact on their business, several mentioned concerns about the rising costs of fluids due to supply and demand pressures. There were also concerns about the fairness of the distribution of fluids between human and veterinary health sectors and the impact on the profitability of veterinary practices. 

 The IV fluid shortage has created a stressful situation for veterinarians, with many expressing frustration over the lack of local supply and the perceived inadequacy of current mitigation strategies. The AVA will continue to advocate for supply and provides a reminder of the resources provided below to assist veterinarians:  

The AVA survey on IV fluid shortage impact will remain open until October 14.  

 

Update 26 September

IV Fluids shortage impact – take the 2 min survey here by 14 October

The AVA is seeking your input on the impact of the ongoing IV fluid shortage. This brief, 2-minute survey is designed to ensure our advocacy continues to be informed by the situation in clinics and robust, evidence-based data. Since the crisis began, we've encountered a range of experiences across the profession, from minimal disruption to significant challenges. We seek your ongoing input to ensure we continue to represent these experiences accurately as we work with industry, regulatory and government stakeholders to push for timely solutions. We greatly appreciate your participation in helping us strengthen the advocacy we undertake on your behalf.

Take the 2 min survey here by 14 October.

 

Update 20 September

Use of unapproved therapeutics and off-label use

The AVA is seeing an increasing number of IV fluid products entering the market in response to the current supply shortage. Some of these products may not have been approved for veterinary or human medical use. While sometimes necessary, off-label use or the use of nonregistered products carries inherent risks, including the potential for adverse reactions or ineffective treatment. Veterinarians must be well-informed about the responsibilities associated with this use, which include ensuring that the decision is based on sound clinical judgment and that the use is clearly communicated with clients. The AVA document Off-Label Use of Therapeutics outlines legal, ethical, and safety considerations for veterinarians to consider when using products in a manner not explicitly indicated on their label.

How is the IV fluid shortage impacting you? – please fill in our 2-minute survey here.

The AVA is seeking input from veterinarians to better understand how the current IV fluid shortage continues to affect practices. Your feedback is essential in helping us advocate effectively for solutions to this critical issue. We invite you to take 2-minutes to complete this short survey, which will provide valuable insights into the extent of the impact and assist the AVA in advocating for your needs. Your voice is vital - please help us by participating by Monday 14 October.

Update 6 September

On Monday, the AVA participated in the National IV Fluids Working Group. The group will continue to meet weekly. It includes representatives with executive oversight and procurement leaders from all Australian jurisdictions, clinicians in both the public and private hospital sectors, alongside representatives from community health care providers, ambulance providers, the TGA, the Australian Medical Association, the AVA, the Australian and New Zealand College of Anaesthetists and the Commonwealth with engagement and updates from industry representatives. 

More information on the IV Fluids Working Group can be found here

Update 30 August

After meeting with Federal Health Minister Mark Butler's office in Canberra last week, the AVA has now been included in the National IV Fluids Working (Response) Group. In our recent advocacy in Canberra, the AVA advocated for veterinary representation in this group, so that the Minister and the Response Group would be informed on overall fluid demand across the human and veterinary medical professions and the impact of the supply crisis on the community as a whole.

On August 27, Minister Butler announced that an extra 22 million IV fluid bags had been secured over the next six months. The AVA will continue to advocate for the profession and provide updates to members to clarify what volume or percentage of this will be available for veterinary use.

The AVA continues to work with industry and the APVMA to help facilitate access to IV fluids for the veterinary sector. 

 A reminder that AVA guidance for practitioners on unregistered veterinary therapeutic products or off-label use can be found here. 

Update 23 August

Earlier this week, the AVA met with several parliamentarians at Parliament House in Canberra. We stressed the impact of the supply crisis on the veterinary profession and advocated for better supply chain management and increased transparency on supply issues. This week, the AVA also connected with the Office of the Chief Veterinary Officer regarding the IV Fluid issue. Late last week, we shared information with the state veterinary boards and received positive feedback that they will share AVA material and information with their databases.

A reminder of the resources provided below – a document provided by the Executive of the ANZCVS Veterinary Anaesthesia & Analgesia Chapter to assist with managing the IV Fluid shortage,  material that can be used for client communication,  and AVA guidance for unregistered/off label use.

Update 16 August 2024

This week, the AVA continued to advocate for information and progress on the supply of IV fluids for the veterinary profession. The situation has remained in the news, with the media interviewing several industry stakeholders. AVA President, Dr Sally Colgan, has done multiple interviews on this topic, including this one from Friday 16 August.

The AVA has connected and shared information with the Australian Medical Association (AMA), as we both grapple with the effects of this disruption to supply of one of our most widely used therapeutics. We have also shared information with the veterinary boards, multiple practices,, Animal Medicines Australia, regulatory professionals, and commercial companies involved in this space.

We have spoken with large and small veterinary practices to inform our advocacy. From this, we understand that the supply situation is patchy and that while some practices have been able to implement measures to manage supplies, some practice supplies are at critically low levels.

The AVA remains actively engaged in addressing the IV fluid shortage. We understand the challenges this critical shortage poses to veterinary practices across Australia. The AVA will continue to provide updates as more information comes to light on the supply chain situation and the impact of the fluid shortage in Australia and overseas.

Please refer to earlier AVA updates on this webpage (below) for helpful resources and guidance, inlcuding this one on off label veterinary therapeutic use, and this one on client communication. 

Additional information:

TGA update 8 August 2024 - https://www.tga.gov.au/about-IV-fluids-shortages

The Australian newspaper 15 August 2024 – video article click here

 

Update 9 August 2024

The AVA remains actively engaged in addressing the IV fluids shortage by collaborating with regulatory experts, companies, and directly with affected veterinarians.

We understand the significant challenges this critical shortage is posing to veterinary practices across Australia. In response, several companies are working to import unregistered IV fluids into the Australian market. The AVA is providing support to ensure that quality-assured supplies are made available as quickly as possible.

Guidance for practitioners on using unregulated veterinary therapeutic products or off-label use can be found here.

Update 2 August 2024

The AVA has continued to advocate for veterinary access to IV fluids and this week has been in contact with the APVMA, suppliers and companies in this space, regulatory affairs professionals and The Australian Medical Association (AMA). This collaborative effort reassures us that we are not alone in this issue.

The AVA also gained insight from a wide range of veterinary practices to ensure our advocacy is informed by current market status. The AVA is aware that various companies are looking to import IV fluids into the Australian market.

The AVA President has been a prominent figure in the media, actively participating in media interviews over the past week, including this interview with ABC Radio South Australia, where the President discussed the IV fluids shortage issue.

The AVA will continue to advocate for solutions to the supply issues and will provide updates to members.  

Newly added resources:

  1. Communicating with clients on IV fluid shortage. The AVA has produced guidance material to help when communicating with clients. 
  2. American Animal Hospital Association (AAHA) resources. Fluid therapy algorithms which can be used to decide what, if any, fluid therapy is needed, and how to best utilise resources most efficiently (link).
  3. Equine - non sterile oral drench saline recipes – EVA Executive co-authors
  4. Equine - enteral fluid therapy in the horse – author Hadley Willsallen, EVA
  5. TGA information in IV fluid shortage: https://www.tga.gov.au/about-IV-fluids-shortages
  6. The current NSW Health Brief: https://www.health.nsw.gov.au/sabs/Documents/2024-sa-012.pdf

Previously shared resources: 

  1. A document here provided by the Executive of the ANZCVS Veterinary Anaesthesia & Analgesia Chapter to assist with managing the IV Fluid shortage. 
  2. Baxter letter to wholesalers Baxter Fluid Supply Communication Wholesalers 22.07.2024 (ava.com.au)
  3. Recipes if needed (please see 20 July update below).

 

Update  26 July 2024

The AVA is actively collaborating with manufacturers and distributors to secure IV fluid supplies for the veterinary profession. We are exploring all potential avenues, including facilitating the importation of stock into Australia in compliance with regulatory requirements.

A recent communication from Baxter to wholesalers has not indicated when their normal supply will resume. The AVA recommends conservative and judicious use of existing stock while the supply uncertainty continues.

As shared previously, please find here a document provided by the Executive of the ANZCVS Veterinary Anaesthesia & Analgesia Chapter to assist with managing the IV Fluid shortage. 

The AVA will continue to work on this issue and provide further updates as they become available.

 

Update: 20 July 2024

The AVA is actively exploring various options to address the IV fluids shortage, including support for initiatives to source IV fluids from overseas suppliers. This process requires approval from either the APVMA or TGA. The AVA is facilitating the progress of fast-tracking imported supplies, which involves navigating regulations and communicating with relevant stakeholders and authorities, a process that can take some time.

Our advice from the Executive of the ANZCVS Veterinary Anaesthesia & Analgesia Chapter is that in-house compounding of IV fluids is not recommended, and should only be considered as a last resort due to significant risks associated with formulation errors, loss of sterility, and introduction of air into the system.

If all other options have been exhausted, hypertonic saline can be added to sterile water for injection to make isotonic crystalloid.  Options to make 1L of 143 mmol/L sodium chloride:

Add 120ml of 7% hypertonic sodium chloride (1.2mmol/ml) to 880 ml of sterile water for injection;

or

Add 270mls of 3% hypertonic solution (0.5mmol/ml) to 730ml of sterile water for injection.

A sample of the constituted fluid could then be run through a blood gas machine or biochemistry analyser to measure the sodium as a cross check.

Further guidance to manage the shortage can be found here.

 

Update: 11 July 2024

The AVA is actively exploring and supporting options to increase the supply of IV fluids to veterinarians, to help alleviate the current shortage.

We have been in touch with various manufacturers of IV fluids to discuss the situation and to ascertain how alternate sources may be made available, and will update you on these initiatives as they progress.

Update: 26 June 2024

The AVA is aware of a shortage of IV fluids impacting veterinary practices across Australia. Members have reported that they have been experiencing the impacts of this shortage. 

This shortage is impacting both the veterinary and human health sectors. We understand that it is a result of manufacturing issues at major suppliers.

While an earlier NSW Health brief anticipated a June resolution, our enquiries confirm the shortage persists, affecting 0.9% NaCl and potentially other IV fluids. 

At this stage it is unclear how long the shortage will last. Members are advised to manage their existing stocks carefully. 

Please find here a document provided by the Executive of the ANZCVS Veterinary Anaesthesia & Analgesia Chapter to assist with managing the IV Fluid shortage. We are very grateful to them for this detailed and helpful document. We thank the Emergency and Critical Care Chapter for additional advice also.

The document includes comprehensive information on:

  • Stock Management: Review and manage current stock quantities, liaise with wholesalers, and ensure back orders are placed.
  • Alternative Preparations: Use alternative volume preparations such as smaller bags, commercial pre-drawn saline flush syringes, and other clinically appropriate fluids.
  • Judicious Fluid Selection: Select appropriate IV fluids based on clinical needs.
  • Administration Practices: Use sterile techniques, syringe pumps, and intermittent bolus administration to avoid wastage.
  • Contamination Minimisation: Use labelled and dated fluid bags, avoid contamination risks, and use sterile techniques.
  • In-house Compounding: Compounding fluids should be a last resort due to risks associated with formulation errors and sterility issues.

Member alert originally published 21 June 2024. Updated 26 June 2024