CAHAN Disease Notification -Guidance for IV Saline Disruption
Hurricane Helene has severely damaged facilities at a Baxter International plant in North Carolina, resulting in its closure. Baxter International is a major manufacturer of intravenous and peritoneal dialysis solutions in the United States.
Baxter International has provided suggestions for management and conservation (see link below and attached). The California Department of Public Health (CDPH) and The Emergency Medical Services Authority, in partnership with the Regional Disaster Medical Health System will be assessing local and regional supply. The HHS Administration for Strategic Preparedness and Response (ASPR) is tracking potential impacts and CDPH is in contact with ASPR.
Baxter Suggestions for Management and Conservation attached.
American Society of Health-System Pharmacists Fluid Shortages – Suggestions for Management and Conservation:
https://www.ashp.org/drug-shortages/shortage-resources/publications/fluid-shortages-suggestions-for-management-and-conservation?loginreturnUrl=SSOCheckOnly
Attachment:
BAXTER
September 30, 2024
Dear Valued Customer:
In follow-up to the communication issued on September 29, 2024 regarding Baxter’s North Cove, NC
facility and the disruption of site operations as a result of Hurricane Helene, below is information
from Baxter’s Medical Affairs team regarding immediate product management and conservation
actions.
Healthcare practitioners should use their professional judgment in evaluating the information in this
document and assessing the needs and resources of their individual organizations.
If you have questions related to the content of this letter, please email
MedInfo@Baxter.com.
Suggestions for Management and Conservation
Please refer to the list of Product Codes manufactured at Baxter’s North Cove facility beginning on
page 2 of this document.
• Evaluate Inventory: Review your current stock levels, expiration dates, and the distribution of
IV and irrigation solutions (e.g., saline, dextrose, lactated Ringer's) and impacted medications
to identify the most critical areas. Prioritize the use of fluids that are most essential for
patient care.
• Evaluate Clinical Needs: Work with clinical teams to identify which patients are in most
urgent need of impacted IV solutions, such as those undergoing surgery, critically ill patients,
or those with severe dehydration or shock. You may want to consider reevaluating protocols
for fluid administration to prevent unnecessary usage.
• Identify Alternative Sources of Solutions and Medications: Recommend the use of alternative
IV fluids or solutions when appropriate, such as oral rehydration for non-critically ill patients.
Consider using smaller volumes or concentrated forms of fluids, based on clinical guidelines.
Consider alternative sources or formats of equivalent medications including medications with
similar pharmacological actions and indications.
• Optimize Fluid Management: Implement evidence-based fluid management protocols to
optimize IV fluid administration and minimize waste. For instance, reducing IV fluid bolus
volumes for routine patients or switching to other therapies like enteral feeding. Consider
fluid conservation strategies, such as reducing maintenance IV fluids in less critical patients.
Consider changing medications and electrolytes to a clinically appropriate oral product
whenever possible.
• Assess Pharmacy Operational Strategies: Consider transitioning to commercially
manufactured premix medications, including multichambered parenteral nutrition bags, if
available. Consider changes in the electronic health record (EHR) to allow the use of either
dextrose or saline for admixture of drugs compatible with both solutions. This will help create
better flexibility based upon which products are available at the time. If your institution can
utilize syringe infusions pumps, consider preparing and dispensing non-IV push medications
in ready-to-administer syringes to be infused via syringe pump.
2
• Engage Clinical Teams: Provide education and training to healthcare providers on managing
fluid restrictions, medication and therapeutic changes and the potential risks. Regularly
update all staff on the status of the shortage and any changes to treatment protocols.
• Document and Monitor: Maintain thorough documentation of impacted fluid and medication
usage, patient needs, and any adverse effects or shortages encountered. Set up a
monitoring system to track fluid and medication consumption closely and ensure transparent
reporting to leadership.
Baxter is continuing to take immediate action so that we can resume production in North Cove as
quickly as possible to help mitigate the effect on product supply for patients. We thank you for your
partnership as we navigate this situation.
References
Suggestions for Management and Conservation. American Society of Health-System Pharmacists.
Drug Shortage Resource Center, 2022.
https://www.ashp.org/drug-shortages/shortage-
resources/publications/fluid-shortages-suggestions-for-management-and-conservation
Product Codes Made in North Cove
Code Description NDC
10019055
61
BREVIBLOC PREMIX NACL INJ SOL 10MG/ML 250ML X 10 10019-0055-61
10019075
87
BREVIBLOC PREMIX INJ 2000 MG 100ML 20mg/mL DBL
STRG BAGS
10019-0075-87
2B0062Q DEXTROSE 5% INJECTION USP 250M L MIGRATED 00338-0017-02
2B0063Q DEXTROSE 5% INJECTION USP 500M L MIGRATED 00338-0017-03
2B0064X DEXTROSE 5% INJECTION USP 1000 ML MIGRATED 00338-0017-04
2B0162Q 10% DEXTROSE INJECTION USP 250 ML MIGRATED 00338-0023-02
2B0163Q 10% DEXTROSE INJECTION USP 500 ML MIGRATED 00338-0023-03
2B0164X 10% DEXTROSE INJ USP 1000ML 00338-0023-04
2B0296H 70% DEXTROSE INJECTION (2000ML ) USP 00338-0719-06
2B0304X STERILE WATER FOR INJ.USP 1000ML 00338-0013-04
2B0306 STER WATER FOR INJ. USP 2000 ML (PHARM BULK PKG) 00338-0013-06
2B0307 STERILE WATER FOR INJ. USP 3000 ML (PHARM BULK PKG) 00338-0013-08
2B0309 STERILE WATER FOR INJ. USP 5000 ML (PHARM BULK PKG) 00338-0013-29
2B1024X 2.5% DEX AND 0.45% SOD CHL INJ USP 00338-0073-04
2B1063Q 5% DEX AND 0.9% SOD CHL INJ, U SP 00338-0089-03
2B1064X 5% DEX AND 0.9% SOD CHL ING, USP 00338-0089-04
2B1073Q 5% DEX AND 0.45% SOD CHL INJ, USP 00338-0085-03
2B1074X 5% DEX AND 0.45% SOD CHL INJ, USP 00338-0085-04
2B1094X 5% DEX AND 0.2% SOD CHL INJ, USP 00338-0077-04
2B1134X 20 MEQ POT IN 5% DEX INJ-USP 00338-0683-04
2B1313Q 0.45% SODIUM CHLORIDE INJ USP 00338-0043-03
2B1314X 0.45% SODIUM CHL INJ, USP VIAFLEX PLASTIC CONTAINER 00338-0043-04
3
2B1322Q SOD CHLOR 0.9% INJ USP VIAFLEX PLASTIC 250ML
MIGRATED
00338-0049-02
2B1323N 0.9% SOD CHL INJ, USP 00338-0049-03
2B1323Q SOD CHLOR 0.9% INJ USP VIAFLEX PLASTIC 500ML
MIGRATED
00338-0049-03
2B1324X SOD CHLOR 0.9% INJ USP VIAFLEX 1000ML MIGRATED 00338-0049-04
2B1353Q 3% SODIUM CHLORIDE INJ, USP 00338-0054-03
2B1357X 20MEQ POTASSIUM CHLORIDE 0.45% SOD CHLORIDE INJ,
USP
00338-0704-34
2B1373Q 5% SODIUM CHLORIDE, INJ USP 00338-0056-03
2B1462X CARDIOPLEGIC SOLUTION SOL F/SLUSH 1000 ML X 14 00338-0341-04
2B1473Q 10MEQ POT CHL IN 5% DEX&0.33% SOD CHL INJ,USP 00338-0603-03
2B1614X 20MEQ POT CHL IN 5% DEX & 0.2% SOD CHL ING, USP 00338-0663-04
2B1644X 10 MEQ POT CHL IN 5% DEX%0.45% SOD CHL INJ-1000ML 00338-0669-04
2B1653Q 10 MEQ POT CHL IN 5% DEX 0.45% SOD CHL INJ,USP (500
ML)
00338-0671-03
2B1654X 20 MEQ POT CHL IN 5% DEX & 0.4 5% SOD CHL INJ, USP 00338-0671-04
2B1664X 30MEQ POT CHL IN 5%DEX & 0.45% SOD CHL INJ, USP 00338-0673-04
2B1674X 40 MEQ POT CHL IN 5% DEX&0.45% SOD CHL INJ, USP 00338-0675-04
2B1764X 20 MEQ POT CHL IN .9% SOD CHL INJ,USP 00338-0691-04
2B1984X 40 MEQ POT CHL IN 0.9% SOD CHL INJ 00338-0695-04
2B2073Q LACTATED RINGER'S AND 5% DEXTR OSE 00338-0125-03
2B2074X LACTATED RINGERS & 5% DEXTROSE INJ, USP 00338-0125-04
2B2103Q 5% DEXTROSE AND ELECTROLYTE NO 48 INJ. 00338-0143-03
2B2224X 20 MEQ POT CHL IN LACTATED RINGER'S AND 5% DEX 00338-0811-04
2B2322Q LACTATED RINGER'S INJ, USP 00338-0117-02
2B2323Q LACTATED RINGER INJ, USP VIA FLEX PLASTIC CONTAINER
500ML
00338-0117-03
2B2324X LACTATED RINGER INJECTION, USP 1000ML VIAFLEX
CONTAINER
00338-0117-04
2B2434X 20MEQ POT CHL IN 5% DEX&0.9% SOD CHL INJ, USP 00338-0803-04
2B2454X 40 MEQ PJOT CHL IN 5% DE1X&0.9 % SOD CHL INJ, USP 00338-0807-04
2B2534X PLASMA-LYTE 148 INJ (MULT ELECINJ TYPE 1, USP) 00338-0179-04
2B2543Q PLASMA-LYTE A INJECTION PH 7.4 (MULTIPLE 00338-0221-03
2B2544X PLASMA-LYTE A INJECTION PH 7.4 MULTIPLE 00338-0221-04
2B7114X STERILE WATER FOR IRRIG,USP 1000ML 00338-0003-44
2B7116 STER WATER FOR IRRIG USP,2000 ML UROMATIC 00338-0003-46
2B7117 STERILE WATER FOR IRRIG.USP. 3000mL UROMATIC CONT. 00338-0003-47
2B7124X 0.9% SOD CHL IRRIG, USP 1000 ML UROMATIC CONT 00338-0047-44
2B7126 0.9% NACL IRRIG USP 2000 ML UR OMATIC CONTAINER 00338-0047-46
2B7127 0.9% SOD.CHL.IRRIG. USP 3000ML UROMATIC CONTAINER 00338-0047-47
2B7207 0.9% SOD CHL PROCESSING SOL, 3 000 ML FLEXIBLE CONT 00338-0050-47
2B7231 0.9% SOD CHL IRRIGATION, USP I N BAXTER STER CONT 00338-0051-44
2B7231K 0.9% SOD CHL IRRIGATION, USP I N BAXTER STER CONT 00338-0051-44
2B7317 1.5% GLYCINE FOR IRRIG USP, 30 00 ML 00338-0289-47
2B7357 3% SORBITOL IN WATER, 3000 ML UROMATIC CONTAINER 00338-0295-47
2B7477 0.9% SOD CHL IRRIG, USP, 3000 ML ARTHROMATIC 00338-0047-27
2B7479 0.9% SOD CHL IRRIG, USP, 5000 ML ARTHROMATIC 00338-0047-29
2B7487 LACTATED RINGERS IRRIG, 3000 M L ARTHROMATIC 00338-0137-27
2B7489 LACTATED RINGERS IRRIG, 5000 M L ARTHROMATIC 00338-0137-29
4
2D5613Q 10% OSMITROL INJ (10% MANNITOL INJ, USP) 00338-0353-03
2D5632Q 20% OSMITROL INJ (20% MANNITOL INJ, USP) 00338-0357-02
2D5633Q 20% OSMITROL INJ (20% MANNITOL INJ, USP) 00338-0357-03
2J1416 BREVIBLOC INJ VIZIENT 2000MG IN 100ML PREMIX BAG,
SALINE
10019-0668-10
2J1417 BREVIBLOC INJ VIZIENT 2500MG IN 250ML PREMIX BAG,
SALINE
10019-0672-10
2J1419 BREVIBLOC INJ PREMIER 2500MG IN 250ML PREMIX BAG,
SALINE
10019-0670-10
2J1420 BREVIBLOC INJ PREMIER 2000MG IN 100ML PREMIX BAG,
SALINE
10019-0666-10
