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SA hospitals managing saline solution shortage

Puerto Rico's medical supply industry crippled by Hurricane Maria

SAN ANTONIO – Three of San Antonio’s largest hospital systems report they are managing the national shortage of saline solution due to a lack of reliable electricity that crippled Puerto Rico’s medical products industry after Hurricane Maria. 

Saline or sodium chloride and water helps to keep patients hydrated.

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“We’re doing the best that we can to make sure that it does not affect, directly affect, patient care,” said Cynthia Koger, director of pharmacy at the Children’s Hospital of San Antonio.

Elizabeth Allen, spokeswoman for University Health System, said in a statement:

With only three primary manufacturers of IV solutions in the US, the entire supply chain is affected when any one of them has problems with production. The devastation of hurricane Maria to manufacturing plants in Puerto Rico and continued challenges to a reliable source of electricity has created such an event. Although we continue to receive a small allocation from our primary manufacturer, we have had to resort to purchasing products from alternative suppliers at very high premiums, change distribution models, and in some cases to administer drugs via IV push instead of IV solutions. With an undetermined recovery date, one manufacturer has now gained approval to bring product in from other countries to help alleviate the situation.  We will continue to ensure our patients receive optimal pharmaceutical care.

As part of the Hospital Corporation of America, one of the nation’s largest owners of hospitals, Methodist Healthcare has “access to a strong supply chain,” according to spokeswoman Palmira Arellano.

That’s why Arellano said in a statement Methodist Healthcare did not anticipate any effect on patient care.

Standing next to partially empty metal bins normally full of saline solution, Koger said CHRISTUS Health, the parent company of the Children’s Hospital of San Antonio, conducts meetings several times a week with its hospitals to discuss how they’re dealing with the shortage.

“It just trickles down,” Koger said. “It’s not just the fluids, but all the other supplies that go with it.”
She said the plastic bags that hold the IV fluids, the tubing that conveys them, and even the clamps that control the flow are in short supply. 

As a result, Koger said the hospital is trying to make any available allocations last, avoid waste, using syringes when possible, and even asking doctors to prescribe medications that can be given orally, not intravenously.

Koger said, “We’re having to come up with alternate methods to infuse antibiotics, anti-convulsants, anti-fungals, any other injectable medication into our patients.”

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“It’s bleak, very bleak,” Koger said.

Even so, she said, “We’re doing everything we can to make sure that it does not affect, directly affect, patient care.”

She said they expect the shortage to ease in the next 30 days or up to six months from now.

Koger said there are a few U.S. suppliers struggling to keep up with demand.

She said because of Maria’s devastating impact on Puerto Rico’s infrastructure, American companies “weren’t prepared to manufacture that large an amount.”

Koger said she and other senior staff consider the shortage “truly the worst it’s ever been.”


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