Where'd the bicarb and acid go?

All of our clinics are going to 500 flow, i have 150 gallons in the tank and nobody in Houston has any, our clinics are on life support on Acid.

It’s been the subject of high level emails apparently. One of my clinics just had to transfer a 132gallon batch worth dry to another clinic. I’ve taught the ordering techs in my clinics to always keep a buffer on concentrate for stuff like this.. and the moment I questioned other places ordering practices prior to this, I got treated like I’m hording toilet paper for having a 6 week supply of acid on hands at all times. Strange times indeed. Hope things come around soon for the people in dire need.

Crap. Just got hit with this too. They back ordered Bibags and Naturalyte on us.

I would say that we lucked out that *most* of our baths come in drums from Bax-Rock...except even THEY can't keep consistent with deliveries as of late.

Welcome to 2020 II, I guess...(except it was PPE and tx supplies then)

I got a call yesterday from the ICU Medical Director of a hospital we're contracted in to. He said that they will run out of CRRT solutions in a few days and he had "heard" that the solutions could be made with a standard dialysis machine and if it was something we could do. I told him that I was familiar with the process but we had never done it and that I didn't even know if we had the necessary PD bags and tubing and would naturally need the approval of my CMO. I spoke to him and like me, is intrigued to do something new and different. That said, there are a lot of T's to cross and I's to dot before we could do this. My CMO will be contacting them Monday.

If anyone is interested, here is a paper from Hopkins about it but it requires 3D printing a fitting. docs.google.com/document/d/17oXLTEqvOtymh_aiR8cU39uylud2w_QRQCjW2-NXmrA/edit

Here is a good video from The Cleveland Clinic that seems to be simple and uses off the shelf supplies. www.youtube.com/watch?v=1ektoZGu83M

The saline shortage has been hitting my clinics in the southeast. The majority of my clinics are rural so it's a logistical nightmare to try and run around redistributing saline when one clinic lucks up and gets some in. I have a pretty good relationship with my TruBlu drivers and they keep me in the loop on what's happening in the warehouses. My two main warehouses were already severely understaffed before getting hit with the latest covid wave- now they're operating on less than a skeleton crew. Same goes for route drivers. The ones that are still left are getting hammered with extra routes and unfairly fussed at by clinical staff when they bring shipments that are missing supplies. It's wildly frustrating for sure, but I know my driver's can't deliver stuff that isn't available.

I'm pretty sure that it is just 1 bag or most treatments.  We (technical) don't do inventory or ordering so I'm not certain of our actual usage.

By "them" I meant the ICU MD.

Since both of the methods above were done using a Fresenius machine, Monday morning I set up one of our Braun machines to make sure that it could do this also without any alarms.  I used the Cleveland Clinic method though I did not collect the solution in bags, there were no problems at all.

I didn't think there would be any difference but I drew electrolyte samples from the dialysate line and of the "CRRT Solution".  Ca++ and Mg++ were both 0.08 mEq/L higher in the CRRT Solution and all others, including CO2 were identical.

On my way home I started feeling not too good and by 6:00 I felt like I got hit by a truck.  I did a rapid home test and tested positive for COVID so.... I have not been back to the office to get any updates.