From the Guidelines
The Nexplanon removal can proceed as planned since all pre-procedure requirements have been met and the patient understands the implications of device removal. The patient's negative pregnancy test and signed consent forms, including birth control consent, indicate that she is aware of the procedure and its implications 1. The fact that she is not allergic to lidocaine, which will be used for local anesthesia, further supports the decision to proceed with the removal 1.
Pre-Removal Education
Education regarding fertility return, potential side effects, and the importance of feeling the device when in place has been provided to the patient 1. She has been informed that she can become pregnant within 7-14 days after removal, which is crucial for her to understand in order to make informed decisions about her reproductive health 1. The patient has also been counseled about potential side effects of hormonal contraception, including bleeding irregularities, emotional changes, weight gain, headaches, and acne 1.
Mental Health Considerations
Important mental health guidance has been provided, advising her to return to the clinic if she experiences suicidal ideations, or to go directly to the emergency room if she develops suicidal ideations with a specific plan 1. This is particularly important given the potential psychological effects of hormonal contraception 1.
Procedure Details
The removal procedure itself is expected to be straightforward, taking less than 5 minutes to complete, as indicated by the study on progestin implants 1. The patient's device has been in place for 3 years, which is the recommended duration for Nexplanon 1. Overall, with all pre-procedure requirements met and the patient well-informed, the Nexplanon removal can proceed without delay.
From the Research
Nexplanon Removal Procedure
- The patient, a 19-year-old female, is undergoing removal of Nexplanon after having it inserted for 3 years with good results 2.
- A pregnancy test was conducted and the result was negative, and the patient has signed a birth control consent form 2.
- The patient is not allergic to lidocaine and has been educated about the potential side effects of Nexplanon, including bleeding irregularities, emotional changes, weight gain, headache, and acne 2.
Potential Complications and Risks
- The most common adverse reaction to Nexplanon is a change in menstrual bleeding patterns 2.
- Rarely, Nexplanon implants can embolize into the pulmonary vasculature, requiring surgical removal 3.
- Removal difficulties can occur, and risk factors include placement by a private practitioner, weight gain >1 kg since placement, and duration of implant placement >25 months 4.
- The patient has been educated about the importance of feeling the device and returning for removal if she experiences any suicidal ideations 2.
Removal Procedure and Follow-up
- The removal procedure can be performed as an office-based procedure, and all healthcare providers must be trained on Nexplanon before performing insertions or removals 2, 5.
- The patient will experience a rapid return to fertility once the implant is removed 2.
- It is essential to follow up with the patient after removal to monitor for any potential complications or side effects 6.