The Critical Role of Nurses in Intravenous Fluid Conservation

Baxter International’s North Cove Facility in North Carolina was severely damaged by Hurricane Helene on September 26, 2024. The temporary closure of that facility and production interruption has resulted in significant shortages in intravenous, dialysis, and irrigation fluids and supply disruption impacting health care facilities across the United States. The responsibility to effectively and responsibly manage these critical resources has fallen heavily on the shoulders of nursing teams and health care supply chain professionals.

The crucial role of nurses during shortages.

Nurses are responsible not only for administering IV fluids but also for monitoring fluid needs, assessing patient status, and adjusting plans of care accordingly. When these lifesaving fluids become scarce, nurses must ensure that every intravenous fluid or irrigation product is used wisely, balancing patient safety with resource availability.

Why conservation is essential.

The consequences of IV fluid shortages extend beyond inconvenience. Fluids such as 0.9% normal saline and Lactated Ringer’s are vital in stabilizing patients, hydrating those who cannot take fluids orally and serving as carriers for essential medications. Shortages can lead to critical delays in patient care, increased length of stay, and negative outcomes for patients who rely on these fluids for hydration, medication delivery, and other essential elements of care.

Conservation efforts led by nurses can reduce waste, optimizing safe use of available resources and controlling costs associated with waste and error.

Practical Conservation Strategies for Nurses

1. Careful assessment of patient needs: Nurses should thoroughly assess each patient’s fluid needs at frequent intervals. By understanding the specific requirements of each patient, nurses and providers can tailor IV fluid usage, reducing unnecessary administration and preserving vital supplies. For example, nurses can assess a patient’s ability to take fluids orally and subsequently guide a reduction in IV fluid use.
2. Minimizing waste: One key area where nurses can conserve fluids is by minimizing waste. Nurses should thoroughly assess patient’s fluid needs at each care transition, for example when patients are transferred from the ED to inpatient areas, extending use of the same fluid bag during care transitions if this practice is in adherence to a shortage-specific facility protocol update allowing extended hang times. In some instances, nurses may be in the position to work with ordering providers so medication may be administered by means of IV push instead of using an IV fluid bag for administration. Further, nurses may identify situations where IV bags are prepared for use prior to their immediate need. Making just-in-time use decisions may have a significant impact in waste reduction.
3. Monitoring and adjusting IV therapy: Nurses can closely monitor patients receiving IV therapy and collaborate with providers and the health care team to adjust flow rates and volume as indicated by patient condition. This is particularly important for patients whose conditions change, such as those recovering from surgery or experiencing fluctuating levels of hydration. Patients should be reassessed regularly so that intravenous fluids can be switched to oral rehydration when medically appropriate and such transitions should be implemented as quickly as possible.
4. Collaboration with pharmacy and medical teams: Conservation efforts are amplified when nurses collaborate with pharmacists and health care providers. By discussing each patient’s needs and alternative options, nurses can help develop plans of care that prioritize fluid use, especially for patients who have no other hydration options. This team-based approach ensures that critical resources are directed to those who need them most.
5. Education and awareness: Nurses also play a role in educating patients and families about the importance of fluid conservation and gaining their partnership. Encouraging oral hydration when possible and explaining the purpose of conservation can engender collaboration in conservation efforts. These types of discussions can lead to results that protect abilities to maintain elective, outpatient procedures and reduce what could be preventable cancellations or delays.
6. Adherence to safe injection practices: The Centers for Disease Control and Prevention (CDC) has created pragmatic clinical guidance for health care professionals to reduce the risk associated with unsafe injection practices. Most notably during this supply chain disruption, nurses should ensure that IV fluid bags are NOT utilized as a common source between patients and are used for single patient use in accordance with the instructions for use (e.g., avoiding use of ‘community’ IV bags for flush solutions). This is equally true for sterile, single-patient-use vials and saline flush syringe, as they lack preservatives that serve to minimize microbial growth. It is essential for nurses to maintain basic aseptic technique practices and ensure single patient use for these medications to prevent contamination, cross-transmission, and potential patient harm through infection.
7. Identification of adverse outcomes: Use of routine infection prevention and control practices should also be part of emergency response activities. Deviation from best practices such as reuse of single patient items, shared fluid bags, use of fluids not designed or approved for injection or intravenous use, or failure to discard fluids when no longer safe for use are examples of situations that may result in adverse outcomes. Nurses must identify those situations and alert others when there are known or suspected adverse outcomes. Developing reporting networks that include representatives from quality, patient safety, infection control, risk management, and value analysis may be instrumental in early risk identification and prevention of patient harm.
8. Collaboration with health care value analysis professionals: Working together with health care value analysis professionals, nurses can ensure continuity of care is maintained and IV fluid conservation efforts are maximized. The nurse should work with value analysis professionals to develop processes that highlight waste reduction and intentional approaches for fluid uses. These might include reducing infusion items that are rarely or less frequently used and switching to a just-in-time delivery system as a means of stock protection.

The value of nursing leadership in conservation.

As health care continues to face challenges in supply management, the leadership role of nurses in resource conservation becomes even more vital. By implementing effective strategies, nurses help hospitals navigate shortages without compromising patient care. Their daily interactions, expertise in patient management, and commitment to safety make them invaluable advocates for responsible resource use.

IV fluid conservation is not just about reducing waste—it is about ensuring that critical resources are available when they are most needed. Nurses’ actions and adaptability are critical to this effort. In times of scarcity, nurses are essential to maintaining safety and continuity of care and supporting the resilience of health care systems.

Additional Resources for Intravenous Fluid Conservation:

AHVAP Emergency Supply Chain Disruption Resource Center: https://www.ahvap.org/ahvap-certification-center-microcertifications

CDC Health Alert Network:
Disruptions in Availability of Peritoneal Dialysis and Intravenous Solutions from Baxter International Facility in North Carolina

J. Hudson Garrett Jr., PhD, MSN, MPH, MBA, FNP-BC, CIC, is an adjunct assistant professor of medicine in the Division of Infectious Diseases at the University of Louisville School of Medicine and a family nurse practitioner. He is a fellow in the Society for Healthcare Epidemiology of America, the National Academies of Practice, the Association of Healthcare Value Analysis Professionals, and the Infectious Diseases Society of America. Board certified in infection control, patient safety, health care value analysis, health care risk management, and vascular access, he is recognized as a thought leader and frequently collaborates with the CDC, FDA, EPA, and other clinical societies to advance health care safety issues.

Ruth Carrico, PhD, FNP-C, CIC, FSHEA, FNAP, FAAN, is an adjunct professor in the Division of Infectious Diseases at the University of Louisville School of Medicine and a board certified family nurse practitioner. She has worked in the field of infection prevention and control for more than 30 years and is also board certified in infection prevention and control. Her research and clinical practice focus on disease prevention in all settings where care is delivered and involves public health and care of vulnerable populations.