Tension pneumothorax after reversal of a Heimlich valve.

The use of small catheters to treat spontaneous and iatrogenic pneumothoraces has gained widespread acceptance in the medical community. Complications associated with their use are uncommon and are rarely life-threatening [1-4]. These small-caliber chest tubes are frequently attached to the unidirectional flutter valve developed by Heimlich [5] to prevent reaccumulation of air in the pleural cavity, allow ambulation, and simplify nursing care. To our knowledge, no serious complications associated with the use of Heimlich valves have been previously documented. We report a tension pneumothorax resulting from inadvertent reversal of a Heimlich valve. These valves should be carefully secured to their connecting tubes, and the importance of correct orientation of the valve with respect to the connecting tube/catheter should be clearly explained to the patient and attending nursing staff.