We currently use sterile water in our Fisher & Paykel Bubble CPAP system. We have noticed a lot a rain out lately in our circuits, with some of our infants getting "lavaged" at times, and are somewhat worried about infection. What liquids are other NICUs using in their BCPAP systems - 0.25% acetic acid, vinegar mixed in the water, etc, and has any one noticed increased infection rates because of this rain out in the circuits?

We use only sterile water.  Some of the things that we have noticed causing rainout are:  room temperature fluctuations; if the temperature probe enters the circuit outside the incubator (temperature gradient causes condensation in the tubing between the temperature probe and the baby); and position of the tubing and circuit - the humidifier must be lower than the baby and the tubing should be angled so that it runs away from the baby. We have not noticed any increase in infection because of rainout, but the nurses do need to be vigilant in checking the position of the circuit and removing condensate before it gets to the baby by lifting the tubing so that the water drains back into the humidifier. We have worked closely with Fisher and Paykel to refine and troubleshoot the system.  My feeling is that you would still get condensate in the tubing using acetic acid in the water, and I would be more concerned about this getting into the baby.   

Totally agree with JoannieO

We don't use bubble CPAP but raining out in to the tubes in ventilatory circuits is common,

Needs regular draining,

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we are using sterile water .