Air inside IV bags from overseas posing an extra risk in emergencies

ABC NEWS (Australia)

Imported IV fluids containing as much as 12 times more air than those made in Australia are posing a heightened air embolism risk for clinicians to manage. Doctors argue the imported bags could pose an issue in an emergency situation and say they're working to both mitigate the risk and communicate it to other clinicians.

Transcript

00:00Infravenous fluids are used routinely, particularly in hospital care.

00:05In my discipline of anaesthesia, we would use millions of litres a year in Australia

00:10alone.

00:11So they're very widely used, not only in theatre care or the emergency department or the intensive

00:19care care, but also in the general wards as well.

00:22So very widely used.

00:23OK, so up until a few years ago, was there relatively little IV fluid being imported?

00:29Yeah.

00:30From what I understand, the vast majority of fluids used in Australia were being manufactured

00:37within this country, but more recently, there's been a change or a problem of supply and demand,

00:45and that's led to a request that clinicians reduce their overall usage by about 20 per

00:52cent, while we wait for that issue to resolve.

00:56Yeah.

00:57And yeah, so there's been this increase in imported fluids in Australia just because of

01:02supply and demand.

01:03So what's the danger with this larger amount of imports in the system here in Australia?

01:08OK.

01:09So these products, the Australian-made products are very good and very safe.

01:15Now, one of the big differences we're talking about here is that the bags we use made in

01:20Australia have about five mils of air, which is a minimal amount compared to the over 1,000

01:25mils overall volume, say, in a bag of saline.

01:29And what's a standard bag?

01:30What's the volume in a standard bag?

01:32Oh, so the volume in a standard bag for our clinical use, particularly in adults, is about

01:37a litre.

01:38So we use litre bags at a time.

01:40We may give a patient several litres during a fairly standard operation, but it can be

01:45much more than that if they need advanced resuscitation, particularly for hemorrhage or

01:50sepsis.

01:51OK.

01:52So just mention once again that kind of difference between the Australian packs and the imported

01:57in terms of the amount of air in them and what the danger is.

02:00OK.

02:01So the difference is that some of the bags that are being imported to cover the shortage

02:08that we have at the moment have much more air in there and they have more about 60 mils

02:12in the bag.

02:13And the problem is, for most patients, this isn't a problem at all because their intravenous

02:18fluids are run through pumps which have air detectors.

02:22But sometimes, particularly in a crisis, we may need to, you know, such as a patient

02:26is bleeding quite heavily, we may need to give the fluids much faster without a pump.

02:32And this runs the risk that we can, that air can run in.

02:35Now, to run the fluids even faster, we pressurise the bags.

02:38We literally squeeze them with a pressure bag and that forces the fluid faster and increases

02:43the rate.

02:44And that increases the risk of air embolism.

02:47So the volume of 60 mils in even a standard adult could produce a significant sudden drop

02:54in blood pressure.

02:55The reason for that is that you can get like an air lock in part of the heart, in one

02:59of the ventricles of the heart, and that reduces the cardiac up and drops of blood pressure.

03:04If the volume goes in fast enough and, you know, you get a significant air lock, you can

03:09effectively get a cardiac arrest as well.

03:11Although again, this is unlikely even with an air embolism, but we want to try and avoid

03:17all risk, minimize the risk to patients.

03:19Yeah.

03:20And so is there any evidence of any incidents with this so far?

03:23Not this time.

03:24There has been in the past and there is in the international literature.

03:29So it is much more than just a theoretical problem.

03:32Yeah.

03:33It really is a potential threat and this is why we're trying to mitigate it.

03:36We know that people have died from air embolism in the past.

03:39Yeah.

03:40And so how can this be managed now with this extra volume coming into Australia, with the

03:46potentially dangerous situation, with the amount of air in these bags that are in Australia

03:51now about to be used?

03:52How can that risk be managed?

03:55Okay.

03:56Well, what I'd like to say is that it is likely that the number of bags, this particular subset

04:01of the bags we're importing, it's not all of them, it's just a subset, are probably being

04:06carefully used up.

04:07The concern will be that if someone in an emergency grabs a bag and people don't realize

04:11it's one of the bags with 60 mils.

04:13So the jurisdictions have been, you know, the government departments have been terrific

04:19in enhancing education.

04:21The Commission on Safety and Quality and Health Care.

04:22New South Wales Health has done a particularly good job in talking, really having very good

04:27online materials.

04:28We as a college have made it, you know, sort of communicated to our fellows.

04:33So we're trying to have the communication practice.

04:36Yeah.

04:37Again, it is a very unlikely event.

04:39But again, if all the risks line up in a bad scenario, it can happen.

04:43Yeah.

04:44And how does Australia get around this in future?

04:46Should there be some kind of mandated annual production of fluids here in Australia?

04:50Well, some may recall that Minister Butler has, you know, invested more heavily in the major

04:58production centre in Australia.

05:00You know, what this has led us to, you know, really reinforce is we have very high standards

05:07of, you know, pharmaceutics and fluids are a type of pharmaceutic in this country.

05:12There are risks when we have to bring in less, lower quality materials, such as the fluids

05:18in this situation.

05:19And that onshore production and optimal onshore production really is a priority in Australian healthcare.

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