Heimlich Valve in Chest Tube Drainage
A Heimlich valve is a one-way flutter valve that allows air and fluid to drain from the pleural space while preventing backflow, serving as a portable alternative to traditional underwater seal systems for selected pneumothorax patients who are clinically stable and ambulatory. 1
Primary Function and Mechanism
The Heimlich valve is a small one-way drainage device (less than 13 cm long) that connects directly to chest tubing and permits unidirectional flow of air and fluid out of the pleural cavity. 2, 3 The valve functions in any position, never requires clamping, and drains into a flexible collection bag that patients can carry, enabling full ambulation during chest drainage. 2, 3
Clinical Applications
Pneumothorax Management
Catheter aspiration with Heimlich valve attachment can improve success rates for primary spontaneous pneumothorax beyond simple aspiration alone, controlling up to 59% of cases when combined with suction. 1
The British Thoracic Society guidelines recognize Heimlich valves as an acceptable drainage system for selected pneumothorax cases, though water seal devices remain the preferred standard. 4
The valve achieved complete lung expansion in 94.4% of spontaneous pneumothoraces by five days, with 66% showing full expansion within one hour. 5
Advantages Over Traditional Systems
Eliminates the cumbersome underwater seal bottle system that must remain upright and restricts patient mobility. 1, 2, 3
Enables outpatient management of persistent air leaks after lung resection, reducing hospital length of stay and improving quality of life. 6
The valve never needs clamping (unlike traditional chest tubes where inappropriate clamping can cause tension pneumothorax), and regulated suction can be attached if necessary. 3
Important Limitations and Contraindications
When NOT to Use a Heimlich Valve
Avoid in pneumothorax with significant pleural effusion or exudative fluid. Valve blockage occurred when pneumothorax was associated with fluid exudation through the catheter; standard underwater seal drainage is mandatory in these situations. 5
Not appropriate for unstable patients or those requiring mechanical ventilation, who need large-bore tubes (24-28F) connected to water seal systems with suction capability. 4, 7
Not the first-line system for traumatic pneumothorax or hemothorax, where traditional water seal drainage with suction provides more reliable monitoring of air leaks and fluid output. 7
Practical Implementation
The valve connects to standard chest tubing (typically 8-14F small-bore catheters for pneumothorax). 1
It is presterilized, stored ready-to-use, and easily deployed in emergency vehicles or operating rooms. 3
The drainage bag can be held at any level without compromising function, unlike water seal systems that must remain below chest level. 2, 3
Clinical Context and Guidelines Position
While the American College of Chest Physicians and American Thoracic Society recommend water seal devices as the standard drainage system for most chest tubes 4, Heimlich valves represent a valuable alternative for clinically stable patients with uncomplicated pneumothorax who would benefit from early mobilization and potential outpatient management. 4, 2 The key is proper patient selection—avoiding use in cases with significant fluid drainage, clinical instability, or need for precise air leak quantification. 5