Urgent Fluid Conservation Measures

We are anticipating a lengthy timeline for the shortage of IV fluids related to the hurricane damage to the Baxter plant in North Carolina.

Upstate is now taking increasingly strict steps to ensure that we do not experience a complete depletion of certain fluids.

We need immediate provider awareness and actions to protect our critical supply by aiming to reduce fluid and irrigation use by at least 60%

Effective immediately:

• Evaluate the clinical need to continue intravenous fluid replacement at every shift change and bag change.
• Reserve Plasma-Lyte and Lactated ringers for critical needs.
• Use KVO orders only when absolutely necessary.
• Use catheter locks with flushes for all eligible patients.
• Order and administer medications that may be given  by IV push whenever possible
• Discontinue infusions as soon as appropriate.
• IV bags may be used up to 7 days.
• For most blood administration smaller 100mL saline bags can be used.
• Evaluate total fluid requirements for surgeries and transition to oral fluids within 24 hours after surgery.
• No discontinuing and restarting IV fluids when the patient changes locations (example from EMS to the ED, from the OR to the floor / ICU, from floor / ICU to OR)
• Avoid opening and “pre-spiking” bags in anticipation of use for surgery.
• Complete currently hanging infusion bag before switching to a different infusion product, unless clinically contraindicated.
• Change IV medications and electrolytes to a clinically appropriate oral product whenever possible.
• Use smaller volume bags for lower infusion rates:

Infusion Rate	Bag Size
20 mL/hour or less	250 mL
21 mL/hour to 40 mL/hour	500 mL