Best Practice #10 (ARCHIVED) FAQ

Best Practice #10: Eliminate all 1,000 mL bags of sterile water (labeled for “injection,” “irrigation,” or “inhalation”) from all areas outside of the pharmacy.

1. Question: Our colleagues voiced some concerns about the ability to use a larger bag (2 liters) of sterile water for use in humidification with ventilators. The water bag hangs on the arm of the ventilator that is used to support and maneuver the circuit so that it's not resting on the patient. Even the weight of a 1-liter bag is at times too heavy for the arms, and in the past year we have had to replace 3-4 ventilator arms that have broken. The ventilator arms cannot support the weight of a 2-liter bag.

Answer: Sterile water bags used for humidification (1 or 2 liter) were never intended to hang on the articulated arm of the ventilator, which is designed to support the lightweight circuit only. In fact, it would be dangerous to overload these arms. It is easy to understand how they would break, and possibly tug on the circuit and the patient’s airway. Many ventilators come with their own attached pole which is sturdy enough to support a 2-liter sized bag of sterile water used for humidification, although it may be an “add-on” purchase. Other organizations have used IV poles to hang sterile water bags. Although less than ideal, if a separate IV pole is used, we recommend labeling the sterile water bag AND the end of the tubing that is closest to the patient with a label that says, “For Respiratory Equipment-Not for IV Use,” or a similar warning to prevent accidental mix-ups.

Organizations have selected to address this safety concern in a variety of ways. Many have made the transition to 2-liter sized bags, while others are using humidification systems that require hard-sided sterile water bottles instead of the flexible bags. Other organizations have opted (when appropriate) to use passive humidification systems such as heat moisturizer exchangers (HMEs) and HMEs with filters.

^{Rev. 8/29/2016}