From Mr J. S. Monk, MRPharmS
SIR,—The letter from Mr Delaney (PJ, October 30, p708) provides perfect examples for the potential value of central intravenous additive service (CIVAS) units in our hospitals. I agree with him that "we must give those in the front line all the help we can" but believe that our best way of doing this is, wherever possible, to provide those who administer intravenous drugs, be they doctors, nurses or patients themselves, with ready-to-use dose presentations.
So, in the two situations discussed by Mr Delaney, the ideal solutions are achieved by removing the risks altogether. In the case of potassium chloride, rather than agreeing to a request from a consultant anaesthetist to provide ampoules with different coloured labelling to help distinguish them from otherwise look-alike ampoules of water for injections or normal saline, how much better it would have been to agree with the consultant body on the cessation of use of potassium chloride ampoules altogether. These, in my own hospital, have been replaced with a range of commercially available infusions, together with a small range of in-house produced ones to supply situations where commercial infusions do not meet the clinical need. Very occasionally, we also make one-off specials for individual situations. The result is that the risk of inadvertent bolus doses of potassium chloride injection has been reduced to zero.
In the case of the antibiotic injection diluted with lignocaine 2 per cent rather than water for injections, the risk is completely removed when the antibiotic is reconstituted correctly in a CIVAS unit under good manufacturing practice conditions and issued labelled specifically for an individual patient.
Removal of risk from potentially hazardous intravenous administration of drugs is surely the main benefit of, and justification for, CIVAS units. The fact that the units also aid in reducing the workload of those at the ward level with stressful working conditions and over-long working hours, and improve the compliance of administration with prescribed regimens, are additional benefits. It is, indeed, unfortunate that there are still significant numbers of hospital pharmacies which are content to exist without the major contributions to patient care which derive from comprehensive CIVA services.
J. S. Monk
Aseptic Services Manager, Wrexham Maelor Hospital, Wrexham, Clwyd