From the Research
Venous sheaths should be removed as soon as possible after the procedure, ideally within 24 hours. Extended use beyond this timeframe significantly increases the risk of complications such as thrombosis, infection, and vascular damage 1. In critical care settings where continued access is necessary, some institutions may allow sheaths to remain for up to 72 hours with proper care protocols, though this is not ideal practice.
Key Considerations
- While the sheath remains in place, it should be secured properly, the insertion site should be monitored regularly for signs of infection or bleeding, and sterile technique must be maintained during any manipulation.
- Flushing protocols with heparinized saline (typically 10 units/mL) may be required according to institutional guidelines to maintain patency 2.
- The extended presence of a foreign body in the vascular system increases infection risk and can damage the vessel wall through mechanical irritation, which explains why prompt removal is recommended.
- If continued vascular access is needed beyond 24 hours, consideration should be given to replacing the temporary sheath with a more appropriate long-term access device.
Evidence Summary
Studies have shown that early removal of venous sheaths is safe and feasible, with no significant increase in vascular complications when ambulation occurs as early as 3-4 hours after sheath removal 3. However, the quality of evidence varies, and institutional protocols may differ. The most recent and highest quality study suggests that nurse-performed venous sheath removal is safe and effective, with fewer complications when protamine is used for heparin reversal 1.
Recommendations
- Remove venous sheaths as soon as possible after the procedure, ideally within 24 hours.
- Monitor the insertion site regularly for signs of infection or bleeding.
- Maintain sterile technique during any manipulation of the sheath.
- Consider replacing temporary sheaths with long-term access devices if continued vascular access is needed beyond 24 hours.