What should be done if hemostasis is not obtained after ten minutes of holding pressure on an arterial site?

When hemostasis is not achieved after ten minutes of direct pressure on an arterial puncture site, the correct course of action is to resume the original occlusive pressure and repeat the steps. This approach is based on the understanding that it might be necessary to maintain the pressure for a longer duration or adjust the technique to achieve proper closure.

Resuming original pressure allows for continued active control over vessel closure, and repeating the pressure is often sufficient to ultimately achieve hemostasis. The technique might require subtle adjustments, such as the angle or distribution of pressure, which can be better managed by sticking to the method already in place.

While increasing pressure significantly could be perceived as an immediate solution, it risks causing complications, such as tissue damage or discomfort to the patient. Switching to a different closure device prematurely could overlook the potential for achieving hemostasis with the current method and would not address any underlying issues either with technique or patient factors. Consulting a physician immediately may be necessary in specific situations, such as signs of excessive bleeding or patient instability, but generally, attempting to re-establish hemostasis with the current technique is the first logical step after an initial unsuccessful attempt.