Palpation is an important technique for locating nexplanon after insertion and before removal. This work was made possible by the generous support of the american people through the u. Your documentation in the medical record should always reflect precisely your specific interaction with an individual patient. If the implant is placed after the fifth day of menses, then you should use an additional contraceptive method such as a condom for the first 7 days. Learners workbook 1 introduction implanon classic is a onerod implant containing the hormone etonogestrel etg that provides contraceptive protection for up to three years. I use 1 ml of 2% lidocaine to anaesthetise just below the tip.
Nov 01, 2019 nexplanon must be inserted by the expiration date stated on the packaging. Progestogen is similar to the hormone produced by the ovaries. Preparation beforeinserting nexplanon,carefully read the instructionsfor insertion as well as the full prescribing information. Progestin implant removal note patient name is here for removal of her etonogestrel rod implant implanon nexplanon. Implanon nxt insertion and removal training course for. Before inserting nexplanon, carefully read the instructions for insertion as well as the full prescribing information. The insertion depth results shown above table 1 suggest that novice users can employ the prototype to successfully insert both implanon and nexplanon implants. Following the insertion, youll have to wear a pressure bandage for 24 hours and a small bandage for 3 to 5 days. Implanon etonogestrel implant is indicated for women for the prevention of pregnancy. Implanon post insertion instructions the cedar city. A small scar difficulty in removing the implant allergic reaction to. Upon patient arrival ucg test complete patient implant insertion checklist in procedure room implant insertion and consent forms povidoneiodine or chlorhexidine in cup with swabs anesthesia for insertion. Specialist nurses are now able to acquire these skills too. Norplant, the first contraceptive implant, became available in 1983 but was later removed from the market owing to patient dissatisfaction with adverse effects that ultimately led to several lawsuits against the manufacturer.
Contraceptive implant implanon implanon effectiveness. Implanon nxt etonogestrel 68 mg, implant for subdermal use. The copperreleasing iud can be used for 10 years before replacement and is a good choice for women who cannot, or. Total implanon exposure was 2,093 women years 27,322, 28 day cycles.
If the implant is not removed, then the effects of nexplanon will continue for a longer period of time. It is a white plastic rod that is inserted under the skin of the inner, upper arm to stop pregnancy by slowly releasing a progestogen hormone into the body. It comes preloaded into a needle, which forms part of a disposable injection delivery system or applicator, for depositing implanon into the subcutaneous or sub dermal beneath the skin space. Learn about how effective nexplanon is and talk to your doctor to see if nexplanon is right for you. In these pivotal studies a total number of 1,286 subjects using implanon were studied. How to insert implanon nxt updated the implant insertion site as described in how to use implanon nxt. It is the most effective hormonal contraceptive available today, preventing 999 in pregnancies over its recommended period of use. Implanon etonogestrel implant side effects, images, uses. Training to insert implanon to increase the uptake of longacting reversible contraceptive methods, there is an urgent need for more health professionals to be trained to insert implanon. In procedure room povidoneiodine or chlorhexidine in cup with gauze. Ventura family medicine nexplanon insertion procedure note. To increase the uptake of larc methods, there is an urgent need for more health professionals to be trained to insert implanon. Nexplanon fda prescribing information, side effects and uses. Failure to insert nexplanon properly may go unnoticed unless it is palpated immediately after insertion.
Family planning implanon insertion record dhmh 4673 102207 page 1 of 2 family planning implanon insertion record. An incision of 2 mm is made in the skin with a scalpel. It requires a minor procedure for insertion and removal. I have been practising a technique for the removal for the past 8 years that i have found to be easier than the traditional one. Implanon must be removed by the end of the third year and may be replaced by a new. Advise the date for removal for the woman to record. Pdf insertion and removal of a single implant contraceptive. Implanon must be removed by the end of the third year and may be replaced by a new implanon at the time of removal, if continued contraceptive protection is desired. You may need a backup method for the first 7 days after implant placement to prevent pregnancy. Deep insertions may lead to difficult or impossible removals. An area on the inner arm above the elbow is first numbed with local anaesthetic.
Keywords etonogestrel implant, implanon nxt, insertion of implanon, contraception, progesterone aim to guide staff in the procedure of inserting an implantable contraceptive. The insertion site was identified on the inner side of the nondominant upper arm, 8 10 cm from medial epicondyle of the humerus and 35 cm posterior to the sulcus groove between the biceps and triceps muscles. The contraceptive implant is a popular form of reversible longacting contraception. Perform a pregnancy test before inserting nexplanon. The implant may not be placed in your arm at all due to a failed insertion. You should notify your other health care providers that you have the implanon.
The implant must be removed by the end of the third year and may be replaced by a new implant at the time of removal, if continued contraceptive protection is desired. A suggestion for removing and reinserting implanon. Total implanon exposure was 2093 women years 27322, 28 day cycles. Undetected failure to insert implanon may lead to an unintended pregnancy. To help make sure the implant is inserted just under the skin, the healthcare providers should be positioned to see the advancement of the. In order to have a proper insertion one should pay special attention to. You may have some pain at the site of the implanon insertion. Nexplanon should be inserted subdermally so that it will be palpable after insertion, and this should be confirmed by palpation immediately after insertion. Before insertion, the skin is cleaned with an antiseptic and the insertion area anesthetized. It is more than 99% effective, relatively riskfree, and works. Jan 01, 2005 the intrauterine device iud is an effective contraceptive for many women. Sprayon anesthesia or 2 cc 1% lidocaine with 25 gauge x 1. This course combines online learning and assessment, simulated practice,supervised clinical. Implanon is a new singlerod progestinonly contraceptive implant that is easily inserted and can remain in place for up to 3 years.
The contraceptive implant, available in australia as implanon nxt, is a highly effective 99. Implanon birth control implant implanon contraceptive. Keywords etonogestrel implant, implanon nxt, insertion of implanon, contraception. After these steps have been accomplished, the device can be used to facilitate the insertion of the implant. Some women experience skin bruising when it is first put in the arm. Contraceptive implant placement periprocedural care. The use of implanonnexplanon has been growing in general practice and family planning clinics since its introduction in 1999. Furthermore, novices were able to insert the implants at the desired insertion depth more consistently using the assistive device. Insertion procedure to help make sure the implant is inserted just under the skin, the hcp should be positioned to see the advancement of the needle by viewing the applicator from the side and not from above the arm.
Updated positioning for the womans arm, which should be flexed at the elbow with her hand underneath her head or as close as possible. Infections at the incision site are usually are minor. The forms are designed for use in a threestage process an initial consultation followed by the insertion and removal of the implant. This involves a small procedure by a doctor who has been specifically trained in insertion and removal of the implant. Insertion and removal for nexplanon etonogestrel implant. Most doctors will discuss the advantages and disadvantages of the device at one visit and make arrangements for a woman to return for insertion at the correct time in her cycle, when the doctor can ensure the woman is not pregnant.
Procedure to follow after insertion of all contraceptive implants. Gently grasp the implant and then flip the forceps over into your other hand figure 17. Onthejob training course for current implant providers. The procedure normally takes the same time as an injection. Assistive device for the insertion of ethiopia to identify. The clinical procedure first involves marking the insertion site 810cm above the epicondyle on the underside of the arm.
Apart from common local reactions to the insertion procedure see insertion technique, longerterm skin reactions are possible. Nexplanon also has an improved trocar, the surgical instrument used to insert the rod. If the tip of the implant does not become visible in the incision, insert a forceps preferably curved mosquito forceps, with the tips pointed up superficiallyinto the incision figure 16. Remember that your implanon implant will not be protecting you from pregnancy for 14 days from the time of insertion. Proper insertion will later facilitate removal and result in minimal scarring. The implant can remain under your skin for 3 years. The insertion of implanon nxt involves a small plastic implant containing the hormone progestogen being inserted underneath the skin of the upper inner arm to act as a contraceptive against pregnancy for up to three years. Failure to insert implanon properly may go unnoticed unless the implant is palpated immediately after insertion. There are case reports of skin atrophy 45,46 at the site of subdermal implants, and fibrosis around the implant has also been documented.
Women who cannot use hormonal contraception containing estrogen have a variety of progestinonly contraceptive methods from which to choose. Implanon nxt procedures and local anaesthetic use 9. Continuous use of an additional reliable contraceptive. Training to insert implanon lee 2010 trends in urology. Schedule the insertion at a specific time of your menstrual cycle for example, within the first 5 days of your regular menstrual bleeding. With tworod implants, the lng is maintained at an effective level for 45 years, regardless of the brand.
Insertion procedure for nexplanon etonogestrel implant. Insertion and removal for nexplanon etonogestrel implant 68 mg. Overview of the implanon nxt checklist and consent form. Instruments and supplies for insertion and removal of. All templates, autotexts, procedure notes, and other documents on these pages are intended as examples only. An aseptic technique is used for insertion of implanon nxt. Counsel women about the insertion and removal procedure of the implanon implant. It is recommended that the hcp is in a seated position during the entire insertion procedure so that the insertion site and the movement of the needle just under the skin can be clearly seen from the side. Insertion and removal of intrauterine devices american. Nexplanon is a longacting up to 3 years, reversible, hormonal contraceptive method.
Following the removal of implanon return to normal ovulation was investigated. Provide the woman with a copy of the patient labeling and ensure that she understands the information in the patient labeling before insertion and removal. All guidelines should be read in conjunction with the disclaimer at the beginning of this manual. Aseptic technique and gentle touch must be followed during implant insertion and removal to prevent infections. Failure to remove implanon may result in infertility, ectopic pregnancy, or inability to stop a drugrelated adverse event. In these pivotal studies a total number of 1286 subjects using implanon were studied. Other problems related to insertion and removal include pain, irritation, swelling, bruising, scarring, infection, injury to the nerves or blood vessels, and breaking of the implant. Fact sheet the contraceptive implant family planning nsw. She is within 5 days of her menses or pregnancy has been reliably excluded. Adverse reactions were not observed in breastfed infants exposed to etonogestrel through breast milk. Insertion procedure for nexplanon etonogestrel implant 68. Jan 29, 2018 the contraceptive implant is a popular form of reversible longacting contraception. May 19, 2017 based on daily milk ingestion of 150 mlkg, the mean daily infant etonogestrel dose one month after insertion of implanon is about 2.
The contraceptive implant implanon nxt is a soft plastic stick about 4 cm long. Call the merck national service center at 18778884231 if you have any questions. Implanon clients for allowing us to observe them during the implanon insertion procedure. Implanon fda prescribing information, side effects and uses. Nexplanon, a birth control implant, might be an ideal contraceptive choice for you. Nexplanon is inserted under your skin on the inside of your upper arm. To this end, facilitating uptake of implanon training is vital. The second appointment, to insert the implant, needs to be with a doctor or nurse trained in this procedure. Updated insertion instructions and figures, and added new figures to aid the hcp to. Implanon birth control implant is a soft cylindrical rod measuring 4cm in length and is 2mm thick in diameter. The table in this brief indicates which instruments and supplies are needed for both insertion and removal of the hormonal implants currently available. After insertion and re insertion, provide the woman with the card that comes in the pack and clear post insertion instructions, including when the method will become effective.
The timing of when you will receive this implant depends on whether you were using birth control before, and what type it was. Implant insertion and removal are within the expertise of all general. Undetected failure to insert the implant may lead to an unintended pregnancy. Nexplanon post insertion instructions the implant starts working in 7 days to prevent pregnancy. Apr 02, 2019 how is the etonogestrel implant used implanon, nexplanon. Implanon should be inserted subdermally so that it is palpable after insertion. Implanon is a longacting up to 3 years, reversible, contraceptive method.
The insertion site was marked with a sterile marker. An informed consent was taken prior to removal and is to be scanned into the electronic health record. An adhesive dressing will be put over the insertion site and a bandage will be put on your arm to minimise the risk of bruising. Local anaesthetic is applied to the skin to make the insertion more comfortable. Videos demonstrating insertion and removal are available online for trained healthcare providers. Then the doctor or nurse puts the implant under the skin. The single rod 4 cm implant contains 68 mg of the progestogen etonogestrel, which is released continuously over three years. Etonogestrel implant is inserted through a needle under local anesthesia into the skin of your upper arm, just inside and above the elbow. Implanon etonogestrel implant 68 mg for subdermal use.
It does not protect against sexually transmissible infections stis. The woman should be counselled about the product, sideeffects, menstrual pattern changes, complications, insertion removal procedures, and followup. After the implant is inserted, a band aid or dressing is put on which should stay on for 35 days. Thus, a single insertion of this method replaces around 1,800 days of. Thus, attention to logistics is critical, and must include instruments expendable medical supplies as well as the contraceptive implant itself. Apr 22, 2019 information concerning the insertion and removal of implanon will be sent upon request free of charge 1877 implanon 18774675266.
The applicator for nexplanon differs from the applicator for implanon etonogestrel implant, which requires a different insertion procedure. Progestin rod implant insertion note patient name comes in today for contraceptive counseling. Highlights of prescribing information nexplanon safely and. Next, the insertion site must be disinfected, and local anesthesia administered. Fibrosis is likely to be greater after a wound infection. Significant migration of implants does not occur if correctly inserted, but frequently the device can be found approximately 2 cm away from the insertion site4. Apr 02, 2019 information concerning the insertion and removal of implanon will be sent upon request free of charge 1877 implanon 18774675266. It is one of the most effective forms of birth control with a oneyear failure rate around 0. Doctors need to understand how to obtain this training, and how to maintain their experience. The implants are inserted with the trocar subdermally, in the shape of a v opening towards the armpit. From the side view, the insertion site and movement of the needle just under. The implant should be removed after 3 years even if you no longer require contraception. Prior to inserting implanon carefully read the instructions for insertion as well as the full prescribing information. Implanon nxt insertion king edward memorial hospital.
Nexplanon should be inserted subdermally in the inner side of the upper nondominant arm. Ensure there are no contraindications to insertion of implanon nxt2 as per kemh clinical guidelines. The implant slowly releases a hormone, progestogen, into your body. Prior to inserting the implant, carefully read and follow the instructions for insertion and removal of the implant in section 4. Procedure completed, batch number sticker affixed to consent form and date of insertion removal of implant recorded on appropriate credit card slip for patient. The author provides an uptodate explanation of the training routes available, for both doctors and nurses. If you are unsure of the necessary steps to safely insert andor remove nexplanon, do not attempt the procedure.
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