What treatments, aside from hot or cold packs, can be used for small hematomas and forearm pain resulting from intravenous (IV) punctures, and is Voltaren (diclofenac) a viable option?

From the Guidelines

For small hematomas and forearm pain from IV pokes, Voltaren (diclofenac) gel is indeed an option, with a recommended dosage of 1% gel applied 3-4 times daily, as per the most recent guidance from 1. When considering treatment options, it's essential to prioritize morbidity, mortality, and quality of life. In this case, the goal is to reduce pain and inflammation while promoting healing.

• Other options include oral NSAIDs like ibuprofen (10 mg kg-1 every 8 hours, as suggested by 1) or acetaminophen (10 to 15 mg kg-1 every 6 hours, as recommended by 1) for pain relief.
• Arnica gel or cream is a natural alternative that may help reduce bruising when applied 2-3 times daily.
• Bromelain supplements (500mg twice daily) can also help reduce inflammation and bruising.
• For immediate care, gentle pressure at the site for 1-2 minutes after needle removal helps prevent hematoma formation, as noted in 1.
• Elevating the arm above heart level for 15-20 minutes several times a day can reduce swelling. These treatments work by reducing inflammation, inhibiting prostaglandin production, or improving blood flow to help clear the bruise faster. If severe pain, increasing swelling, or signs of infection develop, medical attention should be sought, as emphasized by 1.

From the FDA Drug Label

WARNINGS Cardiovascular Thrombotic Events ... Gastrointestinal Bleeding, Ulceration, and Perforation ... Use the lowest effective dosage for the shortest possible duration.

For small hematoma and forearm pain from IV pokes, diclofenac (Voltaren) may be considered as an option, but with caution due to potential risks of cardiovascular thrombotic events and gastrointestinal bleeding, ulceration, and perforation.

• The FDA label recommends using the lowest effective dose for the shortest duration possible to minimize potential risks 2.
• It is essential to weigh the potential benefits and risks of diclofenac and consider alternative treatment options before deciding to use it 2.
• Other options, such as topical NSAIDs or oral acetaminophen, may be considered as alternatives to diclofenac for managing pain and hematoma.

From the Research

Alternatives to Hot/Cold Packs for Forearm Pain and Hematoma

• For small hematoma and forearm pain from IV pokes, alternatives to hot/cold packs can be considered, including topical analgesics and NSAIDs 3, 4.
• Topical diclofenac and ibuprofen have strong evidence for use in treating acute soft tissue injuries or chronic joint-related conditions, such as osteoarthritis 3.
• NSAIDs, including ketorolac, diclofenac, and ibuprofen, have been shown to be safe in the perioperative period, with no increased risk of bleeding complications 4.

Use of Voltaren (Diclofenac) for Forearm Pain and Hematoma

• Voltaren (diclofenac) is a topical NSAID that can be used to treat pain and inflammation in the forearm 3.
• The use of diclofenac has been shown to be effective in treating acute soft tissue injuries and chronic joint-related conditions, with minimal adverse systemic effects 3.
• However, it is essential to follow the recommended dosage and administration guidelines to minimize the risk of adverse effects 3, 4.

Other Considerations for Forearm Pain and Hematoma

• Hematoma block is a safe and effective alternative treatment for pain management and procedural sedation in patients with closed traumatic injuries 5.
• Forearm hematomas can occur after transradial coronary interventions, and predictors of hematoma formation include female gender, multiple puncture attempts, intensive antiplatelet therapy, complex procedure, and longer hemostasis time 6.