The Heimlich Valve for Pleural Cavity Drainage

Introduction: Traditional chest tube fixation and drainage has been undertaken using standard rigid chest tubes connected to under water seal bottles. These are bulky, cumbersome, expensive, and pose a risk of accidental air suction into the chest. One-way valve systems such as the Heimlich valve are small, portable apparatus that allow regulation of fluid flow and require minimal nursing care other than daily charting. Methods: A retrospective descriptive analysis of all chest drains connected to a Heimlich valve between January 2009 and December 2012. Data on indications, duration of drainage and frequency of complications was collected. Results: Fifty seven chest tubes connected to a Heimlich valve were inserted over the study period. Majority were for pleural effusions. No complications were encountered. Four patients (7%) required thoracotomy. The average duration to removal was 6 days and all patients reported satisfactory comfort and mobility. Conclusion: The Heimlich valve is a feasible and cheap alternative method of chest tube drainage with high rates of success and very low morbidity. We propose their usage in resource-constrained settings.Keywords: Thoracentesis, Heimlich, Thoracostom

Surgical site infection rates in breast cancer surgery at a University hospital in Nairobi, Kenya

Back ground: Surgical site infections (SSI)following breast cancer surgery remain a significant cause of morbidity with the use of single dose pre-operative antibiotic prophylaxis. As a result the use of peri-operative antibiotics is common and unregulated, with no knowledge of the infection outcomes with their use. Objectives: To establish the SSI outcomes with the use of peri-operative antibiotic prophylaxis, evaluate the common risk factors for SSI development and assess for other important outcomes following breast cancer surgery. Methods: A prospective surveillance study for patients undergoing breast cancer surgery using the National Nosocomial Infections Surveillance (NNIS) system. Analysis: Analysis for the rates of surgical site infections and the prevalence of common risk factors for SSI development and their importance Outcomes: An SSI rate of 6% was observed using peri-antibiotic prophylaxis and a strict surveillance protocol. This was significantly reduced rate compared with other studies of antibiotic prophylaxis. The most significant risk factors for SSI in the study population were age \u3e65 years, obesity and diabetes. Seroma formation, shoulder dysfunction and medial upper arm numbness were the other surgical complications noted