Heimlich valve: What is it? History, Indications, Installation, Operation, Preparation, Procedure, Advantages and Disadvantages

It can be used in many patients in place of a traditional water seal drainage system.

A flap valve (also known as the Heimlich valve after its inventor, Henry Heimlich) is a one-way valve used in respiratory medicine .

It is a small one-way valve used for chest drainage that ends in a flexible collection device and prevents the return of gases or liquids to the pleural space.

The Heimlich valve is less than 5 inches (13 cm) long and facilitates patient ambulation. There are currently several systems on the market.

The Heimlich chest drainage valve was developed so that the pleural cavity drainage process could be accomplished in a safe, relatively simple, and efficient manner.

This valve system has replaced the cumbersome underwater drain bottle system. What’s more; The Heimlich valve system connects to the chest tubing and allows fluid and air to pass in only one direction.

This system works in any position, and does not need to be clamped, if necessary, a regulated suction can be connected.

The valve drains into a plastic bag that can be held at any level, allowing the patient undergoing chest drainage to be ambulatory simply by wearing the bag.

The Heimlich chest drainage valve was developed so that the pleural cavity drainage process could be accomplished in a safe, relatively simple, and efficient manner.

The construction and function of the valve are easily understood by medical and nursing personnel. It is pre-sterilized, stored in a sterile package, and is easily used in emergency vehicles and in the operating room.

Heimlich valve history

First introduced in 1965, the Heimlich Flap Valve is a portable one-way device that was designed to be used as a drainage procedure to avoid the need for intrapleural aspiration after thoracotomy.

The inventor of the valve was Henry Heimlich, an American thoracic surgeon who also first described the Heimlich maneuver.

Soon, it became very popular in the outpatient management of patients with prolonged air leak from various causes, and it has also been used in the emergency treatment of pneumothorax on the battle fronts.

Chest tube Vs. Heimlich valve

A chest tube is a thin, flexible tube that is inserted into the chest to drain fluid, blood, or air from your chest.

A Heimlich valve is a one-way valve that is used with a chest tube to prevent air from getting into your chest through the tube when you breathe.

The tube and valve can be placed in a plastic bag to collect the liquid.

Heimlich valve description

As already mentioned, it is a one-way valve, therefore, it prevents the evacuated air from returning to the chest cavity along the attached chest tube.

The valve is generally designed as a rubber sleeve inside a plastic case where the rubber sleeve is arranged so that when air passes through the valve in one direction, the sleeve opens and lets air through.

It has two nozzles, the inlet nozzle that allows air to pass through the valve through the chest drain tube that is connected to it, and the outlet nozzle that allows air to pass into the environment or a collecting device during expiration.

The rubber cuff is attached to the inlet nozzle in such a way that, during inhalation, it closes, preventing air from being drawn through the valve into the pleural cavity.

The free end of the rubber sleeve is compressed so that the two sides remain in contact with each other to achieve this function.

When air passes through the inlet nozzle into the rubber cuff, the rubber cuff opens allowing air to escape during exhalation.

But during inhalation, the free end remains closed, due to its compression, which prevents air from being sucked back into the chest cavity. In this way, the pneumothorax is evacuated safely.

By the same mechanism, the Heimlich float valve can also facilitate fluid evacuation.

When using the Heimlich valve

A chest tube is used when fluid and air need to be drained from the chest. For example, it can be used if you have a collapsed lung. A collapsed lung, or pneumothorax, occurs when air enters the space between your rib cage and one of your lungs.

Air pushes part or all of the lung, causing it to collapse. Then it is difficult to breathe and your body receives less oxygen. If left untreated, the air can also put pressure on your heart and cause life-threatening problems.

You may have blood in your chest if you have had a serious chest injury. You may have fluid if you have a lung irritation or infection.

The chest tube and Heimlich valve:

  • Allow air, blood, or fluid to escape from your chest and do not allow it to return inside the chest.
  • Makes it easier to breathe.
  • It reduces the discomfort and the risk of complications.
  • Facilitates the removal of mucus and secretions from your chest.

Heimlich valve installation and operation

It is most often used to help remove air from a pneumothorax. The inlet nozzle is firmly attached to one end of a chest drainage tube, while the other is inside the patient’s pleural cavity.

The end of the drainage tube is placed into the patient’s chest cavity, into the air or fluid to be drained.

The flap valve is placed in the proper orientation (most packages are designed so that the valve can only be attached in the proper orientation), thus evacuating the pneumothorax from the patient’s chest.

The accessory can be secured with pieces of tape. The valve is also attached to the chest wall of the patient, but care must be taken that the distal end, the outlet nozzle, remains unobstructed.

As air passes through the valve, a distinct “flutter” sound can be heard, ensuring that the device is working properly.

The absence of sound accompanied by any movement of the rubber cuff during placement means that no air is passing through the valve, indicating resolution of the pneumothorax or possible chest tube obstruction.

Auscultation of the chest or a chest X-ray may be helpful.

How do I prepare for this procedure?

The insertion of a chest tube and Heimlich valve is often an emergency procedure and there is no time for preparation.

If you need a chest tube because you are having surgery inside the chest or for a reason other than an emergency, your healthcare provider will discuss your treatment options and explain the procedure and risks.

You need to understand what your provider will do and how long it will take for you to recover. You have the right to make decisions about your health care and give permission for tests or procedures.

Ask your provider if there are instructions you need to follow before the procedure. Your instructions may include:

  • Changes in the way you take your medicines.
  • What you can eat and drink before the procedure.
  • Stop smoking if you smoke.
  • Get other tests or procedures.
  • Other steps to follow before the procedure.

Tell your healthcare provider if you have any food or drug allergies. Also tell your provider about all the medications and supplements you take.

Plan your care and drive home after the procedure. Talk to your provider about what happens after the procedure, such as:

  • Take medicine to relieve pain, prevent infection, or treat other problems.
  • Avoiding some activities for a while.
  • Symptoms or problems to look out for and what to do if you have them.
  • When you can return to your normal activities.
  • When you should come back for a checkup.

What happens during the procedure?

You will be given a medicine called anesthesia to keep you from feeling pain. Depending on the medicine, you may be awake or asleep during the procedure.

Your healthcare provider will make a small cut on your chest between your ribs. The tube will be placed through the cut into the area to be drained. The tube will connect to the Heimlich valve.

What happens after the procedure?

How long you will need to stay in the hospital will depend on the reason you needed the procedure and your recovery. The average amount of time to stay in the hospital with a chest tube is 6 to 8 days.

You may be given pain medicine after the procedure. The chest tube and Heimlich valve will stay in place until you no longer need them.

Home care

Wash the chest tube insertion site with mild soap and water according to your provider’s instructions. You will need to wash it at least every other day. You may need to wash it more often if there is drainage around the site.

Except when washing the area, keep the valve and the area around the chest tube dry. Do not soak in a bathtub or hot tub and do not go swimming while you have your chest tube or before your incisions heal.

If you shower, place a waterproof dressing over the chest tube, valve, and insertion site. You may need to cover the area in plastic wrap with duct tape around all edges to prevent water from escaping.

You will be shown how to place a divided gauze bandage around the insertion site. If your skin has a reaction to the tape, ask your provider about products you can use to protect your skin. Put a new bandage on the site every day.

If there is drain from the valve, you can put gauze pads on the end of the valve to catch the drain, but you need to make sure air can escape from the valve.

Cover the tube or valve with your skin under the insertion site. Make sure there are no pulls or kinks in the chest tube. Do not block the valve tip with tape, an airtight bandage, or anything else.

Do not hold the chest tube unless your provider tells you to. Keep the connection between the chest tube and the Heimlich valve firmly taped.

If the stitches holding the chest tube in place break, tape the tube to your skin and call your healthcare provider.

Do not put lotions, powders, or ointments on the area around the insertion site. Remember that noises such as flapping or duck sounds from the valve are normal.

Follow all other instructions your healthcare provider gives you. Keep all follow-up visits with your provider.

Disadvantages of the Heimlich valve

Every procedure or treatment has risks. Some possible risks of this procedure include:

Problems with anesthesia, infection, or bleeding. Ask your healthcare provider how the risks apply to you. Be sure to discuss any other questions or concerns you may have.

There are several potential problems with these valves. One is that the chest tube can get clogged. When chest tube obstruction occurs, pneumothorax or subcutaneous emphysema may recur. This can also lead to empyema.

The other is that these tend to leak fluid. To address this, some have turned to small chest drainage alternatives, such as the Atrium Express Mini 500 or the Teleflex Mini Sahara.

An alternative solution is to connect a sputum trap to the valve, thus providing a reservoir to capture the drainage fluid.

The Atrium Pneumostat Chest Drain Valve combines a one-way valve and a 30cc collection chamber to solve this problem.

Flutter valves or Pneumostat valves allow patients to ambulate more easily and patients can leave the hospital in certain cases.

The traditional chest tube collection box would often require a longer hospital stay.

Advantages of the Heimlich valve

The Heimlich Flap Valve has some significant advantages compared to underwater seal drainage, the most important of which is its small size and portability, allowing immediate patient ambulation, a very important factor in the successful treatment of pneumothorax. .

It can work in any position and does not need clamping. It has a small production cost, which allows it to be a disposable device, without the need to re-sterilize it.

Its function is easy to understand for both medical personnel and the patient, due to the distinctive sound and movement of the rubber sleeve.

If there is a need for fluid evacuation, the distal end can be attached to a collection device, eg, a bag or Bulau device. Underwater suction or negative pressure can also be applied to the outlet nozzle if required.

The size of the drainage tubes to which it can be attached can vary (small or large gauge tubes).

It can be used for a prolonged period in cases where the air leak is persistent and surgical treatment is excluded, allowing outpatient management of these patients.

Complete expansion of the lung is indicated by the absence of the “fluttering” sound and immobilization of the valve’s rubber tube during breathing and coughing.

After full expansion is diagnosed and confirmed, the system (chest tube drain and valve) can be removed from the patient.

Heimlich valve precautions

Small recurrences of pneumothorax have been described in the literature, but are generally insignificant. Probably the most important thing about the Heimlich float valve is that it only works properly under a specific orientation.

This means that if it is improperly connected to the chest tube drain, it will not work at all. In addition, the patient is at great risk of developing tension pneumothorax, a very serious complication that can be fatal.

If the outlet nozzle is attached to the tube, the rubber sleeve cannot be opened (due to compression), air cannot be evacuated, and it accumulates in the pleural space, sometimes causing tension pneumothorax. Case reports describing this complication have been published.

For this reason, all valves have distinctive markings on the housing that clearly indicate the inlet and outlet nozzles and the proper orientation of the valve during placement, so valve reversal can be avoided.

Care must also be taken when attaching bags or other collection devices to the outlet nozzle, so as not to block the nozzle and prevent air evacuation. During the outpatient management period, frequent inspection of the valve by medical personnel is mandatory.

Another major complication of Heimlich’s flutter valve is the increased risk of developing chest empyema. This occurs through infection of the pleural space, mainly due to the prolonged time remaining for drainage of the chest tube and valve.

Valve placement must be performed under sterile conditions (the valve itself is presterilized) and all accessories must be secured and airtight, to avoid further infection.

Accidental valve dislodges have been reported in the literature. In such a case, reattaching the valve may be associated with an increased risk of infection.

There are no reports of death in the literature, even in cases of accidental valve inversion and the development of tension pneumothorax.

This demonstrates that the Heimlich float valve is a safe and effective procedure for treating pneumothorax, if used correctly, and if properly instructed by the patient and medical staff.

Caring for your Heimlich valve and chest tube

Your chest tube will be covered with a bandage. Change your bandage every 7 days. Clean the skin around your chest tube with soap and water before applying the new bandage.

If your bandage is wet, dirty, has come loose, or has started to lift off the skin, apply a new one.

If your chest tube is draining fluid, your Heimlich valve will be attached to a plastic container or drainage bag. The type of collection device used will depend on the amount of fluid being drained.

If your Heimlich valve is attached to a small plastic container, write down the amount on the container and flush it down the toilet.

If your Heimlich valve is connected to a drainage bag, your doctor may have you measure the amount of fluid that is draining. Write down the amount and flush the bag down the toilet.

To flush the fluid, open the valve at the bottom of the drain bag and flush it down the toilet.

The chest tube can irritate the wall of your chest and cause discomfort. Your doctor can prescribe pain medication, if you need it.

Showering with your Heimlich valve

You can shower, but you will need to keep your dressing dry. A manual shower head can help direct the water away from your bandage.

You will also need to cover your bandage. If the bandage gets wet, it will need to be changed. Wet bandages are a common cause of skin problems.

Repairing a Disconnected Heimlich Valve

The Heimlich valve should never be disconnected from your chest tube. If you get disconnected, follow these steps:

Reconnect it immediately by inserting the blue end of the valve into the tube on your chest. Cough deeply This will help remove any excess air that may have accumulated in your pleural space when you disconnect your Heimlich valve.

Call your doctor or nurse if:

  • You have a temperature of 101 ° F (38.3 ° C) or higher.
  • Your skin around the chest tube is red, swollen, or feels hot and painful when you touch it.
  • You have pain that is not relieved by your pain medicine.
  • The amount of drainage from the chest tube increases.

Heimlich valve contraindications

There are no specific contraindications to the use of a Heimlich float valve in the literature.

Relevant contraindications can be large hydropneumothorax with large volumes of fluid in the pleural space or thick secretions and blood that can cause occlusion of the rubber tube due to adhesions or clots, preventing the escape of air.

If such a case occurs, replacement of the valve or under the water seal drain is mandatory.

Studies have shown the safe use, with good results, of the valve in cases of treatment of primary pneumothorax and in many different cases of secondary pneumothorax in patients with Pneumocystis carinii (PCP), AIDS, cystic fibrosis, lung metastases, etc.

Advances of the future

Today’s technological advances have allowed the construction of small portable drainage devices under sealed water.

They also facilitate immediate patient ambulation after placement and have fewer complications than the Heimlich flutter valve in cases where the pneumothorax is accompanied by large volumes of fluid or blood.

This has led to limited use of the valve in recent years, but it still has a place in the outpatient management of patients with prolonged air leak, for whom additional surgical treatment is not an option.