Heimlich Valve in Pneumothorax Management
What is a Heimlich Valve?
The Heimlich valve is a one-way flutter valve that connects to a chest tube and allows air and fluid to drain from the pleural space while preventing backflow, functioning as a portable alternative to traditional underwater seal drainage systems. 1, 2
The valve is small (less than 13 cm long), functions in any position, never needs to be clamped, and drains into a flexible collection bag that allows patient ambulation. 1, 2
Clinical Applications and Success Rates
Primary Spontaneous Pneumothorax
When attached to small-bore catheters (8F) for catheter aspiration of pneumothorax (CASP), the addition of a Heimlich valve may improve success rates beyond simple aspiration alone. 3
- Success rates of 65.5% have been reported for outpatient management of primary spontaneous pneumothorax using small-bore (8F) chest drains with Heimlich valves, with complete lung re-expansion occurring in 94.4% of cases by five days. 4, 5
- The British Thoracic Society guidelines note that catheter aspiration kits with integral one-way valve systems may reduce the need for repeat aspiration. 3
Technical Developments
Recent technical developments have allowed the addition of Heimlich flutter valves to both small tubes (7-14F) and larger bore tubes, expanding their utility across different pneumothorax scenarios. 3
- Small lumen Teflon catheters (2 mm) inserted over needle and guidewire, when attached to a flutter valve after partial aspiration, achieved success in 27 of 28 patients with a mean drainage time of 48 hours. 3
Key Advantages Over Traditional Systems
Patient Mobility and Safety
The Heimlich valve eliminates the cumbersome underwater seal bottle system, allowing immediate patient ambulation while maintaining safe one-way drainage. 1, 2, 4
- The valve functions in any position and never requires clamping, avoiding the well-known dangers of traditional water trap systems. 2, 4
- Patients can be managed as outpatients in appropriate cases, simply carrying the drainage bag. 2, 5
Procedural Simplicity
The valve is presterilized, easily understood by medical and nursing staff, and readily utilized in emergency settings and operating rooms. 2
Clinical Scenarios for Use
Iatrogenic Pneumothorax
For interventional procedure-induced pneumothorax in cancer patients, Heimlich valve drainage is micro-invasive, safe, and can achieve complete lung re-expansion in 2-3 days with outpatient management in selected cases. 6
Ventilated Patients
In ventilated patients with suspected bronchopleural fistula, large-bore chest tubes (24F-28F) can be connected to water seal devices, though Heimlich valves may be incorporated if suction is needed. 7
Important Limitations and Contraindications
Valve Blockage Risk
The Heimlich valve should NOT be used when there is significant pleural effusion or exudative fluid, as blockage can occur; standard underwater seal drainage is recommended in these situations. 4
- Tube blockage by haemoserous discharge occurred in 1.8% of cases in one series. 5
- Tube dislodgement occurred in 5.5% of cases. 5
Active Air Leak Precautions
Never clamp a chest tube with an active air leak (bubbling), whether connected to a Heimlich valve or underwater seal, as this can convert a simple pneumothorax into a life-threatening tension pneumothorax. 3, 7, 8
Optimal Patient Selection
The ideal candidates for Heimlich valve use are patients with primary spontaneous pneumothorax, first episode, unilateral, with at least 2-cm rim of air and minimal or no pleural effusion. 5