Group A (21 patients) had their chest tubes connected to an underwater seal drainage bottle, while group B (20 patients) had their chest tubes connected to a flutter bag drainage device. Forty-one patients presenting with non-massive malignant and paramalignant pleural effusions were consecutively divided into two groups. Approval was obtained from the Hospital's Health Research and Ethics Committee. Patients with non-massive malignant or paramalignant pleural effusions admitted into the Lagos University Teaching Hospital (LUTH) from January 2014 to December 2014 were prospectively enrolled in the study. This study intends to compare the use of flutter valve drainage system as a safe and useful alternative to conventional underwater seal drainage in management of non-massive malignant and paramalignant pleural effusions. They are rendered immobile and their tubes get blocked from repeated clamping during transport with increased risk of iatrogenic pneumothorax and hospital-acquired infections.

These patients often compete for limited bed space and they are hospitalized for at least a week. Patients with non-massive malignant or paramalignant effusions end up with underwater seal drainage devices after chest tube insertion. Thus pleural effusions that do not fulfill this definition can be regarded as non-massive pleural effusion. Massive pleural effusion can be defined on plain radiograph as, complete opacification of an entire hemithorax with or without mediastinal shift. Malignant pleural effusion is the commonest indication for insertion of chest tube and drain in Lagos Nigeria and a great number of such individuals are females with breast cancer. Malignant Pleural Effusion (MPE) complicates the course of various malignancies, with most cases occurring secondary to pleural metastasis of lung and breast adenocarcinoma. labels this group as paramalignant effusions. In patients with established malignancy and pleural effusion, when malignant cells have not or cannot be detected in the pleural fluid or tissue, Sahn et al. Malignant pleural effusion is confirmed by the presence of malignant cells in pleural fluid or tissue. This was similar to what was found earlier by Thomas et al. , also found that neoplastic diseases were the commonest cause of pleural effusions. showed that the flutter drainage system is a safe and feasible system when pleural drainage is needed in the treatment of pneumothoraces and pleural effusions.Pleural effusion is an abnormal accumulation of fluid in the pleural space and neoplastic diseases accounts for 13% to 40% of all the pleural effusions worldwide and account for 70% of all massive effusions. The one-way valve system provides better mobility of patients because clamping is unnecessary during transportation and the valve keeps working regardless of its position/level. The flutter valve drainage bag is a ‘no water’ ambulatory system which incorporates a one-way valve and can be used both in hospital and outpatient drainage of pleural collections. , showed that bags with integral non-return valves could be used for chest drainage.

In 1968, Henry Heimlich idealized a device (The Heimlich valve) to replace under water-seal drainage systems and this is the concept of the flutter valve drainage bag as popularized by Portex USA. The frequent clamping during transport can cause pulmonary collapse, formation of clots and can result in worsening of an existing pneumothorax. Placement of underwater seal below the chest wall often causes disconnection of the connectors and it also puts tension on the anchoring stitch, resulting in increased risk of chest tube mishaps. Thoracic drainage systems are designed to remove air and fluid from the pleural space and the underwater seal drainage system in its present form was first described by Kenyon in 1916 and since then has been the standard form of chest drainage.

Flutter device nhs