Australia’s IV fluid shortage is likely to continue throughout the year. Here’s what it means for surgery

The current shortage of sterile intravenous (IV) fluids is a serious ongoing concern for doctors across Australia. During surgery, these sterile fluids are needed to administer medications and hydrate patients intravenously (intravenously).

But the supply of the two most common solutions is very low.

The Australian government has recently moved to coordinate the supply of IV fluids to increase production and ensure distribution. However, supplies are not expected to return to normal levels by the end of the year.

So, what will this mean for surgery in Australia? And is there any alternative?

Why do we need IV fluids for surgery?

IV fluids are used before, during, and after surgery to maintain blood volume and normal body functions. They also combat dehydration, which can occur in a number of ways.

Before surgery, patients may become dehydrated from illnesses that cause constipation or diarrhea. They are also told to stop eating and drinking for several hours before surgery. This is to reduce the risk of stomach contents regurgitating and being breathed into the lungs – a complication that can cause injury or death. But it can dehydrate them too much.

During surgery, the body continues to lose fluid through normal processes such as sweating and urination. But some aspects of surgery also increase dehydration, for example, through blood loss or when internal organs are exposed and lose more fluid through evaporation.

After the operation, IV fluids may be necessary for several days. Many patients may not be able to eat or drink until bowel function returns to normal.

Several research studies, including a trial of 3,000 patients who underwent major abdominal surgery, have shown the importance of adequate fluid therapy during all phases of surgery to prevent kidney damage.

In addition to hydration, these sterile fluids—prepared under strict conditions to contain no bacteria or viruses—are used in surgery for other reasons.

Anesthetists usually use fluid infusions to slowly deliver drugs into the bloodstream. There is some evidence that this method of maintaining anesthesia, compared to inhalation, can improve patients’ “waking up” experience after the procedure, such as feeling light-headed and having less nausea and vomiting.

Surgeons also use sterile fluids to clean wounds and surgical sites to prevent infection.

Are there solutions?

The fluid that is given intravenously should closely match the salt in the blood to prevent additional problems. The safest and cheapest options are:

• isotonic saline, an aqueous solution with 0.9% table salt
• Hartmann’s solution (compound sodium lactate) which combines a range of salts such as potassium and calcium.

Both are in short supply.

One way to work around the shortage is to increase how much IV fluid is used during the procedure. This can be achieved by ensuring that those admitted to surgery are as hydrated as possible.

Most people presenting for minor surgery can safely drink water an hour or so before their operation. A recent innovation called “sip ’til send” has shown that it is safe for patients to drink small amounts of fluid until the operating theater team “send” for them from the waiting room or hospital ward.

However, it may not be suitable for those who inhale stomach contents, or patients taking medications, including Ozympic, that delay gastric emptying. Patients should follow their anesthetist’s advice on how to prepare for surgery and when to stop eating and drinking.

Large research trials have also helped develop protocols called “improved recovery after surgery.” They show that using a special hydrating, carbohydrate-rich drink before surgery can improve patients’ well-being and speed healing.

These protocols are common in major bowel surgery in Australia but are not used internationally. Widespread adoption of these procedures may reduce the amount of IV fluids needed during and after major operations, and help patients return to normal eating and drinking earlier. Medicines that reduce nausea and vomiting are still routinely administered to help with this after surgery.

What will the shortage mean for surgeons?

The Australian and New Zealand College of Anesthetists has advised anesthetists to reduce fluid intake during operations where there may be limited or minimal benefit. This means that the liquid will be used only for people who need it, without changing the quality and safety of anesthesia care for each patient.

Even with these actions, there is still a chance that some planned surgeries may be delayed in the coming months.

If necessary, these aborted operations would likely require large amounts of liquidity and would cause unacceptable risks if delayed. Similar to cancellations during the height of the COVID epidemic, emergency operations and surgeries for cancer are unlikely to be affected.

Monitoring of supply and honest and open communication between senior health managers and clinicians will be critical in reducing disruption to surgical services.