Anesthesia Team Implements Algorithm to Manage IV Fluid Shortage During Natural Disaster

In response to a significant IV fluid supply disruption caused by flooding that affected the Baxter manufacturing plant, the anesthesia department at the Medical University of South Carolina (MUSC) devised an innovative strategy to conserve fluids without compromising patient care. As the first anniversary of Hurricane Helene's flooding in North Carolina approaches, the team shares their approach to managing the crisis effectively.

The anesthesia team, led by Dr. Carlee A. Clark, emphasized the importance of preparedness in clinical practice, especially during emergencies. With over 80 locations across seven hospitals, MUSC faced the challenge of reducing IV fluid usage across its diverse settings while ensuring surgeries and procedures continued seamlessly.

To address this, the team set a goal to decrease IV fluid use by 60% around surgical procedures starting October 1. They adhered to NPO guidelines, allowing patients to hydrate orally with clear liquids up until two hours before their surgeries, resulting in better-than-expected hydration levels among patients upon arrival.

A key innovation was the development of a decision-making algorithm tailored for both inpatient and outpatient procedures. This was particularly impactful in outpatient centers, including a children's surgery unit, adult eye and orthopedic centers, a hospital-based surgery unit, and an endoscopy clinic. The algorithm helped the teams determine when IV fluids could be reduced or replaced with smaller syringes called flushes—used to administer medications and to minimalize fluid waste.

The strategy was carefully monitored over a month, assessing markers such as intraoperative hypotension, postoperative nausea, and recovery times. Findings showed no significant increase in complications, confirming that fluid management modifications did not adversely affect patient safety.

Post-crisis, the team reviewed their practices, shifting from routine one-liter fluid bags to more tailored sizes depending on the procedure and patient needs—focusing on patient care and resource conservation rather than cost. They also promoted preoperative hydration education for patients, which improved their overall experience.

The successful collaboration among perioperative nurses, surgeons, anesthesiologists, and pre-op staff exemplifies effective teamwork during a resource crisis. Clark highlighted the importance of collective problem-solving and adaptability, noting that the experience has led to lasting changes in their fluid management protocols.

This proactive approach during the IV fluid shortage demonstrates how healthcare providers can adapt swiftly to natural disasters and supply disruptions, ensuring continuity of care while conserving vital resources. The findings are published in "A&A Practice" under the study titled "Fluid Crisis Management: Intravenous Fluid Conservation Strategies and Outcomes After a Natural Disaster".