Case reports have been published describing this complication (6-8). If the outlet nozzle is attached to the tube, the rubber sleeve can’t open (due to its compression), the air can’t be evacuated and is accumulated in the pleural space, sometimes leading in tension pneumothorax. Furthermore, the patient undergoes great risk of developing tension pneumothorax, a very serious complication that may be fatal. This means that if it’s connected wrongly at the chest tube drainage it will not function at all. Probably the most important thing about the Heimlich flutter valve is that it only functions properly under a specific orientation. Small recurrences of pneumothorax have been described in the literature but they are usually insignificant ( Figure 2 ).
Flutter valve full#
After full expansion is diagnosed and confirmed, the system (chest tube drainage and valve) may be removed from the patient. Full expansion of the lung is indicated by absence of the “flutter” sound and the immobilization of the rubber tube of the valve during breathing and coughing. It may be used over a long-term period in cases that air- leakage is persistent and surgical treatment is excluded, allowing the outpatient management of these patients. The size of the drainage chest tubes that it can be attached to, may vary (small or large calibre tubes) (5). Also negative pressure or under water suction may be applied to the outlet nozzle if needed (1). If there is need for fluid evacuation, the distal end may be attached to a collecting device, e.g., a bag or Bulau device. Its function is easily understood both by the medical staff and the patient, due to the distinct sound and movement of the rubber sleeve. It has a small production cost, thus allowing it to be a disposable device, with no need of re-sterilization. It can function in any position and doesn’t need clamping (4). The Heimlich flutter valve has some significant advantages compared to under water seal drainage, the most important being its small size and its portability, allowing this way the immediate ambulation of the patient, a very important factor in the successful treatment of pneumothorax (1). Auscultation of the chest or a chest X-ray might be helpful. Absence of the sound accompanied with no movement of the rubber sleeve during placement means that no air passes through the valve, which indicates either the resolution of pneumothorax or possible clogging of the chest tube. When air passes through the valve, a distinct “flutter” sound can be heard, ensuring that the device is working properly. The valve is also attached to the patient’s chest wall, but care must be taken that the distal end, the outlet nozzle, remains unimpeded (1). The attachment may be secured with pieces of adhesive tape. The inlet nozzle is securely attached to one end of a chest drainage tube, while the other one lies within the patient’s pleural cavity. By the same mechanism, the Heimlich flutter valve may also facilitate the evacuation of fluid. This way pneumothorax is safely evacuated.
Flutter valve free#
But during inhalation the free end remains closed, due its compression, preventing the air to be sucked back in the thoracic cavity. When the air passes through the inlet nozzle in the rubber sleeve, the latter one opens allowing the air to escape during expiration. The free end of the rubber sleeve is compressed, so that the two sides remain in contact with each other, in order to achieve this function. The rubber sleeve is attached to the inlet nozzle in such a manner that, during inhalation, it closes off, thus preventing air to be sucked in, through the valve, to the pleural cavity ( Figure 1 ). It has two nozzles, the inlet nozzle which allows the air to pass in the valve through the chest drainage tube attached to it, and the outlet nozzle which allows the air to pass to the environment or a collecting device during expiration. The valve is made of a plastic case with a rubber sleeve inside. As already mentioned, it is a one-way valve, thus it prevents the evacuated air from travelling back to the thoracic cavity along the attached chest tube. Soon, it became very popular in the outpatient management of patients with prolonged air-leakage from various causes (2), and has also been used in emergency treatment of pneumothorax in battle fronts (3).
The inventor of the valve was Henry Heimlich, an American thoracic surgeon who also first described the Heimlich maneuver.
Flutter valve portable#
introduced in 1965, the Heimlich flutter valve is a one- way portable device that was designed for use as a drainage procedure in order to avoid the need for intrapleural suction after thoracotomy (1).
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