Availability of IV Fluids Update

Further to DrugAlert vol 957, HPS Pharmacies wish to advise that multiple suppliers are continuing to experience a supply interruption for various IV fluids, including all volumes of the following products:

• Glucose 5% bags (Baxter, B. Braun, Frensenius Kabi)
• Hartmann’s solution bags (Baxter, B. Braun, Frensenius Kabi)
• Sodium chloride 0.9% bags (Baxter, B. Braun, Frensenius Kabi)
• Water for injection bags (Baxter, B. Braun, Frensenius Kabi)

As this supply interruption may continue until the end of the year, it is important to manage available supplies appropriately.

One area where IV fluids may be conserved is in the administration of antimicrobials. Where appropriate, administration via push injection (SC, IM, or IV) may be considered. Antimicrobials that may be considered for bolus IV administration are shown in Table 1.

Table 1. Antibiotics suitable for IV bolus injection (from NSW Health)

*Above recommendations for paediatric bolus apply to injections given over 5 minutes

Additional considerations:

• The data provided in Table 1 identifies medications with data to support their safety and efficacy as a bolus IV injection. However, this administration method may not be appropriate in every case; specific information should be sought for individual patients.
• Administering antimicrobials via IV push increases the risk of thrombophlebitis; monitor patients carefully.
• Additional caution required for medications administered via central lines.
• Antibiotics that exhibit time-dependent killing (i.e. beta-lactams) may not be appropriate for push administration in critically unwell patients.
• Consider principles of antimicrobial stewardship to determine if a switch to oral therapy is appropriate. The Therapeutic Guidelines: Antibiotic provides further information (see Principles of antimicrobial use – Guidance for antimicrobial intravenous to oral switch).

References that should be consulted in each case include:

• Australian Injectable Drugs Handbook – for adult patients;
• Paediatric Injectable Guidelines (Royal Children’s Hospital, Melbourne) – for children; or
• Paediatric Injectable Medicines Handbook (Westmead Children’s Hospital) – for children.

Retain this notice in a prominent position, including in other related business units until supplies return to normal. Report any problems identified with medicines, vaccines or medical devices to the TGA.

Should you require further information regarding this matter, please contact your pharmacist at your local HPS Pharmacies, or email the HPS Pharmacy Standards team at [email protected].

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