In 2023, Australia experienced the worst acute global shortage of these critical intravenous (IV) fluids. The federal and state governments acted decisively, looking for ways to maintain these groundbreaking healthcare advances. The Therapeutic Goods Administration (TGA) provisionally approved multiple overseas products to ease the supply shortages. Since the beginning of the year, more than 1.5 million units of imported IV fluids have come into the country. With these foreign fluids come tremendous risks that health care workers are now caring for.
The imported IV fluids have much more air compared to those produced in Australia. According to reporting, imported products can contain up to 12 times as much air as domestic-made imports. This additional margin of air is particularly egregious. That lack of transparency can promote air embolisms during medical emergencies, resulting in grim complications such as cardiac arrest or stroke.
Air Embolism Risks in Imported Fluids
Air embolism is a rare vascular accident that transpires when an air bubble infiltrates a vein or artery and blocks blood flow. The risk of this dangerous condition goes up tremendously when using pressurized infusions, which are frequently required in critical, emergent circumstances. Australia’s Health Minister Mark Butler added that the risk is still very low. Overall, he sounded a note of caution about moving too quickly to address this problem.
“There’s now a good understanding across the sector that this is a potential risk, and I want to emphasise that it is still low risk, but in medicine we take everything really seriously, and obviously, if there is a risk, we want to manage it,” – Danielle McMullen.
Medical professionals have raised alarms about the large amounts of air that are included in the imported IV fluids. NTC’s own Professor David Story made this key point. The risk for severe outcomes increases along a continuum as the volume of gas becomes larger in proportion to the size of the patient, he explained.
“At about 1-2 millilitres per kilo is where there’s complete loss of blood flow. So the smaller the person, the smaller the volume that would be required to produce very serious complications, including a cardiac arrest,” – David Story.
The increased air content in these fluids adds an extra level of complication during dynamic emergencies when rapid fluid delivery is most crucial. Butler noted that medical teams often deploy pressure bags to increase the rate of fluid flow. This practice, while well-intended, can unknowingly increase the chance of air being forced into a patient.
“However when we have a crisis — so a patient may be bleeding heavily — we need to get fluids in quickly [and] we sometimes put a pressure bag around the bag of fluid to really force the fluid in as fast as we can get it in to resuscitate the patient,” – Mark Butler.
Quality Concerns with Imported Products
Regardless of the very real need for imported IV fluids given the persistent IV fluid shortage, questions about their quality have bubbled up since their arrival. According to Professor Story, such products are not held to the same high standards as the domestically produced products.
“The products being imported are inferior to the ones we routinely use in Australia, but we have had an urgent need to have more fluids,” – David Story.
Given the Australian healthcare system’s heavy dependence on overseas provision, calls are growing for more domestic production capacity to avoid or at least reduce future shortages. Perhaps predictably, during March 2023’s unsettling shortage of IV fluids, the federal government announced a thunderous response — plans to significantly increase domestic production. This program serves to fortify Australia’s supply chain and lessen reliance on overseas suppliers.
Mitigating Risks During Emergencies
Public health advocates have been working to address the dangers from air found in imported IV fluids. Most importantly, they are taking proactive steps to protect patients while they receive care. Air detectors in infusion pumps Most hospitals use infusion pumps that have air detectors built-in. These devices are instrumental in reducing the chance that air will enter a patient’s bloodstream.
“For patients who are getting what we call maintenance fluids, virtually all the pumps we use in Australia have an air detector so that reduces the risk,” – Mark Butler.
Nonetheless, during emergencies where immediate action is required, such as cases involving significant blood loss, clinicians may need to act quickly, which may compromise safety. The lungs are much better adapted to absorbing smaller volumes of air safely. Breathing in greater amounts is a significant risk.
“If you have only fairly small amounts of air, sometimes the lungs can absorb it … however, a much bigger volume — and 60 millilitres is the sort of volume we’re talking about — you can get an air bubble lock in to the heart or the arteries or the lungs, which could prevent blood flow and effectively produce a cardiac arrest,” – David Story.
Australian health authorities continue to be committed to ensuring a careful balance between supply requirements and patient safety. We quickly brought in imported IV fluids to stave off acute shortages. In the meantime, healthcare providers are starting to have serious conversations about the dangers that come with it.
