Dr. Felicity Cole

VIN News Service photo

Dr. Felicity Cole holds a patient, Alfie, recently out of surgery at a hospital she co-owns in Newcastle, Australia. The cocker spaniel is being given IV fluids from a bag initially used for a human blood donor.

All appeared normal in the treatment room of Dr. Felicity Cole's clinic on an overcast and muggy afternoon in the Australian city of Newcastle. The day's scheduled surgeries were done, and four canine patients — including two cocker spaniel siblings with brilliant golden coats — sat peering out of their recovery cages, eyes glazed by the lingering effects of anesthesia.

Each dog was hooked up to a customary bag that provides patients with intravenous fluids after surgery. Only there was something about these particular bags of saline solution that was far from ordinary: They had been used initially on human blood donors.

How bags meant for people had ended up at Cole's clinic, which she co-owns with three colleagues, is a story of ingenuity that has helped her practice and more than 100 others around Australia cope with a prolonged shortage of vital IV fluids.

A cornerstone of care, the fluids are used in human and veterinary medicine for a variety of purposes, such as keeping patients hydrated, replacing essential electrolytes and nutrients, raising low blood pressure and delivering some medicines.

Reports of a nationwide IV fluid shortage were confirmed by Australia's pharmaceuticals regulator last July. Although initially pinned on a global supply squeeze, the shortage has appeared more pronounced in Australia, which has relatively modest domestic manufacturing capabilities that have struggled to keep pace with a surge in demand for medical treatments post-pandemic.

Cole's practice immediately found itself vulnerable.

"In the middle of last year, we were told by our suppliers that 'We can't supply you with IV fluids until Christmas,' " she told the VIN News Service during an interview at the clinic this week. "That was around mid- to late June."

The clinic already was low on stock, since supplies had progressively been getting harder to secure in the preceding weeks and months. Desperate to get ahold of bags, Cole and colleagues asked nearby medical hospitals whether they had any leftovers. "We only got a trickle — no pun intended," Cole said.

To conserve its scant supply, the practice decided to stop putting young, healthy animals on a drip when they were under anesthesia for routine procedures. But the need to resort to that kind of rationing turned out to be short-lived.

Cole had an idea up her sleeve that nobody else had thought of.

A regular blood donor

For more than 25 years, Cole has been a regular visitor to the local blood bank, a tradition she started with her best friend at veterinary school in Sydney.

"I try and donate my blood or plasma half a dozen times a year, and I'm always fascinated by their machinery," she said. "They put the collection bags in these cool little rockers [that prevent coagulation]. As vets, when we collect blood, you're usually rocking the bag yourself. So I've always thought, 'We should have one of those.' "

Apart from admiring the rockers, Cole noticed that individual bags holding 500 to 1,000 milliliters of IV fluids administered to plasma donors are rarely fully drained. (During plasma donation, red and white blood cells are returned to the donor's body, and IV fluids are administered to help maintain circulation).

"The bags end up just going into the bin," Cole said. "I suddenly realized we might be able to use them."

Cole figured that a leftover amount of, say, 200 mL, while perhaps not seeming like much to blood bank staff, could supply an animal weighing 4 kilograms, or about 9 pounds, for 10 to 20 hours.

Not long after the extent of her clinic's supply woes had sunk in, she wrote a letter to the owner of the blood bank — the Lifeblood division of the Australian Red Cross — asking for their leftover bags. The letter reached Lifeblood's national head of waste reduction. Three or four weeks later, Cole said, her practice had all the IV fluid it needed — and more.

It wasn't long before Cole was offering to share surplus volumes with neighboring veterinary clinics, including the local emergency hospital.

Lifeblood proceeded to take Cole's idea national.

The charity worked with its legal and regulatory teams to ensure the partially used bags could be repurposed safely, Belinda Smetioukh, a spokesperson for the group, told VIN News.

Now, 160 veterinary clinics or animal charities across Australia are collecting bags from their local blood banks. "Volumes vary depending on local arrangements and need, but nationally, we have around 5,000 packs that have more than 60 mL [each] available," Smetioukh said.

IV Bag

VIN News Service photo

To minimize contamination risk, repurposed bags used at the Newcastle clinic are dated and connected to an extension line that can be changed if remaining fluids are used on another patient.

Mitigating contamination risk

A key risk that comes with reusing medical equipment that needs to be sterile, such as syringes or IV fluid bags, is contamination.

When the IV fluid crisis started last year, the Australian and New Zealand College of Veterinary Scientists, a professional association for specialists, issued rationing guidelines that included advice such as divvying the content of individual bags into appropriately sized and labeled syringes.

Should one bag be used on more than one patient, the guidelines recommend dating and labeling the opened bag and avoiding hanging the bag over or near a sink, where the risk of contamination is higher.

Cole said her practice followed the guidelines closely for the repurposed bags, including by ensuring that a second infusion line — known as an extension set — was connected to the existing setup. "Between patients, you change and flush the extension," she said. "You're never touching the bag more than once."

When her practice uses one bag for multiple patients, it's typically just two, and they don't keep the bags in use for longer than five days each.

Smetioukh at Lifeblood confirmed the bags are heat-sealed immediately after use at its blood banks, which "keeps the pack as a sealed unit," and enables veterinarians to connect to the spike that punctures the bag for subsequent use.

Leftover amounts in individual bags may vary from between 5 mL up to a full bag, she said.

Has Lifeblood received competing requests from the human medical field? No, said Smetioukh, pointing out that the rules on reuse for human patients are much stricter than for veterinary patients.

"Once spiked, the rules surrounding giving a human anything intravenously are very strict — we cannot re-spike for another human," she said. "There also wouldn't be sufficient volume for its purpose. From a practicality perspective, most vets are asking for the bags that have 100 mL or more left. We leave donor centers and vets to make these agreements locally, depending on their individual needs and capability."

An ongoing supply source?

How much longer veterinary practices will use IV fluid bags repurposed from human blood banks remains an open question. The immediate need appears to be abating as the national fluid shortage eases.

"At least from the perspective of my hospital, our fluid situation is good," said Dr. Andrew Wester, an emergency veterinarian who rationed fluids at a hospital in Melbourne. "We are still careful in what we use, but we aren't feeling the crunch like we did six months to a year ago."

Still, the Australian Veterinary Association said a supply shortfall "remains an ongoing challenge for veterinary practices across the country," noting that Australia's pharmaceuticals regulator, the Therapeutic Goods Administration, said in November that the shortage might persist into 2025.

"We continue to monitor the situation closely and advocate for sustainable solutions to ensure veterinarians have reliable access to the products they need to provide the highest standard of care," the AVA said by email. "Regarding the initiative to repurpose fluid bags from human blood donations, while we acknowledge the ingenuity of veterinarians in responding to shortages, the AVA does not have a formal position on this specific practice. Veterinary professionals must always assess the safety, sterility and regulatory considerations of any alternative products they use in clinical settings."

Lifeblood would be happy to continue supporting others with IV fluid that would otherwise be discarded, Smetioukh said.

For her part, Cole said her clinic's need for the repurposed bags is waning as conventional supplies return to normal.

"Things are much better now," she said, "and so the question, in some ways, is: Do you consider it as an ongoing option to minimize waste?"

She, too, is cautious, maintaining that using one new bag per patient remains the "gold standard" of care.

"I think in order to make it common practice — when there isn't a need because of a shortage — you'd perhaps want someone to demonstrate the ongoing safety of a system like that," Cole said. "So you'd do some studies and some microbiology on the bag."