Stewardship of Intravenous Fluids During Shortage and Beyond

Recent supply chain issues caused by Hurricane Helene highlighted opportunities to improve stewardship of intravenous (IV) fluids.

To quantify IV fluid bags saved by using "round down" strategies designed to limit use of partial bags of IV fluid in the emergency department (ED), and to estimate the associated environmental impact of this intervention.

This was a retrospective analysis of all 30 mL/kg IV fluid bolus orders placed in the EDs at Stanford Healthcare for adult patients from 2020 to 2023. We calculated the number of IV fluid bags that would be saved or reduced in size by rounding down to either the nearest 250 mL or the nearest 500 mL. Projected environmental impact was assessed using previously published estimates of CO₂ emissions and plastic waste generated by IV fluid use.

Across 11,964 30 mL/kg IV fluid orders, rounding down would have saved up to 1567 bags of IV fluid, and reduced the size of IV fluid bag used for up to 3890 boluses. Depending on which "round down" strategy was used, the median reduction in fluid volume was 121 to 244 mL per patient. For each 1000 patients, this reduction was estimated to decrease CO₂ emissions by 112.8 kg and eliminate 14 kg of plastic waste.

Use of a "round down" strategy for IV fluid resuscitation in sepsis could substantially reduce the number of bags of IV fluid used, with associated reductions in CO₂ emissions and plastic waste.