What is the minimum recommended duration to hold manual pressure after a sheath pull?

• A. 10 minutes
• B. 15 minutes
• C. At least 20 minutes
• D. 30 minutes

Answer: (C)

After removing the arterial sheath, the puncture tract needs to seal with a stable clot while arterial pressure gradually drops. Manual compression provides the time and pressure necessary for hemostasis, especially if anticoagulation was used or a larger sheath was involved. If compression ends too soon, the tract can reopen and lead to continued bleeding, a groin hematoma, or even a pseudoaneurysm. Because of these factors, a minimum of twenty minutes of manual compression is typically recommended to allow the clot to form and hold. Shorter durations, like ten or fifteen minutes, are usually not sufficient in many patients, whereas longer compression may be needed in higher-risk scenarios. After achieving hemostasis, monitor the access site for bleeding or hematoma and assess distal perfusion.