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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