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Australia’s IV fluids shortage will likely last all year. Here’s what that means for surgeries

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/stuart-marshall-1115779">Stuart Marshall</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722"><em>The University of Melbourne</em></a></em></p> <p>The current <a href="https://www.tga.gov.au/about-IV-fluids-shortages">shortage of sterile intravenous (IV) fluids</a> is a serious ongoing concern for doctors across Australia. During surgery, these sterile fluids are essential to administer drugs and hydrate patients intravenously (via the veins).</p> <p>But supplies of two of the most common solutions are critically low.</p> <p>The Australian government has recently moved to <a href="https://www.theguardian.com/australia-news/article/2024/aug/16/australia-iv-fluid-shortage-government-distribution">coordinate supplies</a> of IV fluids to increase manufacturing and ensure distribution. Despite this, supplies are not expected to return to normal levels <a href="https://www.health.gov.au/sites/default/files/2024-08/joint-statement-on-iv-fluids-health-ministers-meeting-16-august-2024.pdf">until the end of the year</a>.</p> <p>So, what will this mean for surgery in Australia? And are there any alternatives?</p> <h2>Why do we need IV fluids for surgery?</h2> <p>IV fluids are used before, during and after surgery to maintain blood volume and the body’s normal functions. They also combat dehydration, which can happen in a number of ways.</p> <p>Before surgery, patients may become dehydrated from illnesses that cause vomiting or diarrhoea. They are also asked to stop eating and drinking for several hours before surgery. This is to minimise the risk of stomach contents being regurgitated and inhaled into the lungs – a <a href="https://my.clevelandclinic.org/health/diseases/21954-aspiration-pneumonia">complication that can cause injury or death</a>. But it can also make them more dehydrated.</p> <p>During surgery, the body continues to lose fluid through normal processes such as sweating and making urine. But some aspects of surgery also exacerbate dehydration, for example, through blood loss or when internal organs are exposed and lose more fluid through evaporation.</p> <p>After the operation, IV fluids may be required for some days. Many patients may still be unable to eat and drink until the function of the gut returns to normal.</p> <p>Multiple research studies, including <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1801601">a trial </a>of 3,000 patients who underwent major abdominal surgery, have demonstrated the importance of adequate fluid therapy throughout all stages of surgery to avoid kidney damage.</p> <p>Apart from hydration, these sterile fluids – prepared under strict conditions so they contain no bacteria or viruses – are used in surgery for other reasons.</p> <p>Anaesthetists commonly use fluid infusions to slowly deliver medications into the bloodstream. There is some evidence this method of maintaining anaesthesia, compared to inhalation, can improve patients’ experience of “waking up” after the procedure, <a href="https://medcast.com.au/blog/total-intravenous-anaesthesia-tiva">such as being clearer headed and having less nausea and vomiting</a>.</p> <p>Surgeons also use sterile fluids to flush out wounds and surgical sites to prevent infection.</p> <h2>Are there workarounds?</h2> <p>Fluid given intravenously needs to closely resemble the salts in the blood to prevent additional problems. The safest and cheapest options are:</p> <ul> <li>isotonic saline, a solution of water with 0.9% table salt</li> <li>Hartmann’s solution (compound sodium lactate), which combines a range of salts such as potassium and calcium.</li> </ul> <p>Both are <a href="https://www.tga.gov.au/about-IV-fluids-shortages">in short supply</a>.</p> <p>One way to work around the shortage is to minimise how much IV fluid is used during the procedure. This can be achieved by ensuring those admitted to surgery are as well hydrated as possible.</p> <p>Many people presenting for minor surgery can safely drink water up until an hour or so before their operation. A recent initiative termed “<a href="https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15855">sip ‘til send</a>” has shown it is safe for patients to drink small amounts of fluid until the operating theatre team “sends” for them from the waiting room or hospital ward.</p> <p>However, this may not be appropriate for those at higher risk of inhaling stomach contents, or patients who take medications including <a href="https://www.journal.acorn.org.au/cgi/viewcontent.cgi?article=1291&amp;context=jpn">Ozempic</a>, which delay the stomach emptying. Patients should follow their anaesthetist’s advice about how to prepare for surgery and when to stop eating and drinking.</p> <p>Large research trials have also helped establish protocols called “<a href="https://www.bjanaesthesia.org/article/S0007-0912(17)53976-8/fulltext">enhanced recovery after surgery</a>”. They show that using special hydrating, carbohydrate-rich drinks before surgery can improve patients’ comfort and speed up healing.</p> <p>These protocols are common in <a href="https://aci.health.nsw.gov.au/__data/assets/pdf_file/0003/736617/ERAS-Key-principles-for-colorectal-surgery.pdf">major bowel surgery</a> in Australia but not used universally. Widespread adoption of these processes may reduce the amount of IV fluids needed during and after large operations, and help patients return to normal eating and drinking earlier. Medications reducing nausea and vomiting are now also routinely administered after surgery to help with this.</p> <h2>What will the shortage mean for surgeries?</h2> <p>The Australian and New Zealand College of Anaesthetists <a href="https://www.anzca.edu.au/news/guidance-on-sparing-of-intravenous-fluid-use">has advised anaesthetists</a> to reduce the consumption of fluid during operations where there might be limited or minimal benefit. This means that the fluid will only be used for people who need it, without a change to the quality and safety of anaesthetic care for any patient.</p> <p>Even with these actions, there is still a chance that some planned surgeries may <a href="https://www.abc.net.au/news/2024-08-15/iv-fluid-shortage-elective-urgery-delays/104225280">need to be postponed</a> in the coming months.</p> <p>If needed, these cancelled operations will likely be ones requiring large volumes of fluid and ones that would not cause unacceptable risks if delayed. Similar to cancellations during the height of the COVID pandemic, emergency operations and surgery for cancers are unlikely to be affected.</p> <p>Monitoring of the supplies and ongoing honest and open dialogue between senior health managers and clinicians will be crucial in minimising the disruption to surgical services.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/237009/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/stuart-marshall-1115779">Stuart Marshall</a>, Associate Professor, Department of Critical Care, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/australias-iv-fluids-shortage-will-likely-last-all-year-heres-what-that-means-for-surgeries-237009">original article</a>.</em></p> </div>

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Don’t listen to Gwyneth Paltrow – IVs are not a shortcut to good health

<p>Actor and businesswoman Gwyneth Paltrow <a href="https://jezebel.com/gwyneth-paltrow-iv-drip-1850227472">declared</a> “I love an IV!” recently, calling herself an “early adoptor” of intravenous infusion during a podcast. Both she and the show’s host were hooked up to drips during an interview in which they discussed bone broth, skipping meals and infrared saunas. </p> <p>The Goop boss has been criticised for her “beauty from the inside out” ideas, which she says are <a href="https://www.forbes.com/sites/brucelee/2023/03/18/gwyneth-paltrow-refers-to-her-long-covid-when-responding-to-bone-broth-backlash/?sh=35eacdbf14f0">helping her</a> recover from long COVID and reduce inflammation. </p> <p>Lots of TikTok users are <a href="https://pagesix.com/2023/03/14/gwyneth-paltrow-dragged-on-tiktok-over-wellness-tips/">not having it</a> – but IV supplements have hit the mainstream in recent years. Here’s why they are not a quick fix and can be deadly. </p> <h2>What is IV vitamin therapy?</h2> <p>IV vitamin therapy administers supplements directly into the bloodstream via a needle inserted into a vein. Fans of the therapy believe this route leads to higher nutrients in the body compared with oral supplements or food-based nutrients as it avoids nutrient losses through digestion and excretion. </p> <p><a href="https://9now.nine.com.au/a-current-affair/australian-beauty-clinic-businesses-speak-out-following-medical-regulator-ahpra-crackdown/4fded160-8f07-48f1-afc2-58b6e09863ac">Providers of these injections</a> say they customise the formula of vitamins and minerals depending on the patient’s perceived needs. Many do this without an initial blood test, making it close to impossible to know if you have a pre-existing vitamin deficiency. A typical session in a shopfront or home visit can take 30–90 minutes and cost anywhere between A$80 to $3,000.</p> <p>Popular drip “cocktails” include blends of vitamin C and B complex “for energy”, B complex and zinc “for skin”, vitamin C, magnesium and amino acids “for happiness”, and a supposedly “anti-ageing” blend of glutathione. Many of these contain mostly water-soluble vitamins C and B, which are processed by the kidneys and excess nutrients excreted through urine when the body has received the amount it needs to work properly.</p> <h2>What does the science say?</h2> <p>IV therapy is not new and has been used in the medical profession for decades. In hospitals, it is used to <a href="https://www.nice.org.uk/guidance/cg174">hydrate patients</a>and administer <a href="https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-2-18">essential nutrients</a> if patients have difficulty eating, drinking or absorbing them. Single nutrient deficiencies like vitamin B12 or iron are often treated with infusions under medical supervision.</p> <p>The “cocktails” that IV vitamin therapy clinics create and administer are not supported by scientific evidence. There have been no clinical studies to show vitamin injections of this type offer any health benefit or are necessary for good health. </p> <p>Very few studies have looked at their effectiveness in adults. In those that have, they are either of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC420479/">very poor scientific quality</a>, found <a href="https://pubmed.ncbi.nlm.nih.gov/19250003/">no significant differences</a> and involved only a handful of people, were <a href="https://pubmed.ncbi.nlm.nih.gov/17515022/">missing a placebo group</a>, or contained only <a href="https://altmedrev.com/wp-content/uploads/2019/02/v4-1-37.pdf">anecdotal evidence</a> from single cases.</p> <h2>What’s Gwyneth on about then?</h2> <p>Paltrow <a href="https://podcasts.apple.com/us/podcast/gwyneth-paltrow-her-wellness-protocol-for-longevity/id1539535133?i=1000603890093">recently</a> shared her enthusiasm for glutathione as her favourite IV vitamin therapy. </p> <p>Glutathione is heralded as the “master antioxidant” in the body and is naturally produced by our cells, working to prevent oxidative stress and tissue damage. The body’s demand for this nutrient is believed to increase as we age. Studies have reported that taking an <a href="https://rdcu.be/c8Agw">oral glutathione supplement</a> doesn’t increase <a href="https://pubmed.ncbi.nlm.nih.gov/21875351/">blood levels</a> in humans.</p> <p>In 2015, <a href="https://rdcu.be/c8AdX">a trial</a> reported some beneficial effects on immune function with long-term glutathione oral supplementation, but the authors said more studies were required to further understand the nature of these effects. </p> <p>It is important to note that no research has supported the claim IV therapy with glutathione slows down ageing or reduces oxidative damage.</p> <h2>What could go wrong?</h2> <p>Injecting anything straight into your bloodstream comes with some big risks, especially if those administering the drips aren’t medically trained. </p> <p>Medical doctors tend to avoid inserting IV lines into people unless it’s absolutely necessary (such as for medical emergencies). Air bubbles (or embolism) accidentally introduced via IV <a href="https://www.medicalnewstoday.com/articles/186328">can be fatal</a>. </p> <p>Another major risk is <a href="https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/hypervitaminosis">hypervitaminosis</a>, or consuming too high a dose of a vitamin. Unusually high stores of vitamins in fat tissue can, over time, cause problems like <a href="https://www.nature.com/articles/s41380-019-0375-7">Alzheimer’s disease</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657096/">cancer</a>, <a href="https://www.sciencedirect.com/science/article/pii/B9780128012383994911">kidney issues</a>, muscle spasms, pain, burning and itching. </p> <p>And any time you have an IV line inserted, it creates a direct path into your bloodstream and bypasses your skin’s defence mechanism against bacteria. This can put you at risk of <a href="https://www.magonlinelibrary.com/doi/full/10.12968/bjon.2017.26.14.S4">dangerous systemic infection</a>.</p> <p>IV therapy also puts your wallet at risk. If you are not vitamin deficient, supplements (oral or infused) may just create very expensive urine. </p> <p>There is no regulation of IV therapy by the Therapeutic Goods Act in Australia, so ultimately you could be paying to receive sugar water, rather than the advertised formulas for “anti-ageing”. </p> <p>Many advertisers quote their patients as feeling or looking better after an infusion. The Australian Health Practitioner Regulation Agency (Ahpra) believes there is little or no accepted evidence to support such generalised claims and they are, therefore, misleading and in breach of national laws.</p> <p>In November last year, Ahpra <a href="https://anmj.org.au/wellness-industry-put-on-notice-over-unproven-intravenous-infusion-treatments/">warned businesses</a> about making misleading health claims in relation to infusions. It is also illegal in Australia to misrepresent yourself as a medical practitioner or nurse.</p> <h2>Don’t believe the hype</h2> <p>While it sounds logical that consuming more of a good thing would be good for you, research shows this is not necessarily the case. In a healthy person, nutrient digestion and absorption are carefully regulated to release them into the bloodstream from the gut and liver. Excessive amounts of nutrients entering the bloodstream without undergoing this process may result in harm, and the long-term consequences remain unknown.</p> <p>Most of us are far better off trying to get vitamins and minerals by eating a balanced diet with a wide variety of vegetables and fruits. It’s also much easier, cheaper and safer.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/dont-listen-to-gwyneth-paltrow-ivs-are-not-a-shortcut-to-good-health-202621" target="_blank" rel="noopener">The Conversation</a>. </em></p>

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The Over60 Christmas tree gallery IV

<p>Welcome to the Over60 Christmas tree gallery, a collection of your beautiful decorated Christmas trees. Here’s part four of the collection. Click here to <span>find </span><span style="text-decoration: underline;"><strong><a href="http://www.oversixty.co.nz/news/news/2015/12/over60-christmas-tree-gallery/">part one</a>,</strong></span><span> </span><span><span><a href="http://www.oversixty.co.nz/news/news/2015/12/over60-christmas-tree-gallery-part-2/"><span style="text-decoration: underline;"><strong>part</strong></span><strong> two</strong></a><a href="http://www.oversixty.co.nz/news/news/2015/12/over60-christmas-tree-gallery-part-2/"></a> and <a href="http://www.oversixty.co.nz/news/news/2015/12/over60-christmas-tree-gallery-part-3/"><span style="text-decoration: underline;"><strong>part three.</strong></span></a><a href="http://www.oversixty.co.nz/news/news/2015/12/over60-christmas-tree-gallery-part-2/"><br /></a></span></span></p> <p><strong>Related links: </strong></p> <p><span style="text-decoration: underline;"><strong><em><a href="http://www.oversixty.co.nz/lifestyle/family-pets/2015/11/funny-things-grandkids-say-part-4/">The funniest things grandkids kids say</a></em></strong></span></p> <p><span style="text-decoration: underline;"><strong><em><a href="http://www.oversixty.co.nz/lifestyle/family-pets/2015/11/sacrifices-grandparents-make-study/">The many things grandparents sacrifice for their family</a></em></strong></span></p> <p><span style="text-decoration: underline;"><strong><em><a href="http://www.oversixty.co.nz/lifestyle/family-pets/2015/11/interspecies-animal-friendships/">15 unlikely friendships that will melt your heart</a></em></strong></span></p>

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