From the Guidelines
Nexplanon insertion requires proper training and sterile technique, and the procedure should be performed by a qualified healthcare provider who has received training on the insertion and removal of the implant. The procedure begins with identifying the insertion site on the inner side of the non-dominant upper arm, about 8-10 cm above the medial epicondyle. After confirming the patient is not pregnant and obtaining informed consent, the area is cleaned with antiseptic and anesthetized with 2-3 mL of 1% lidocaine. The sterile, pre-loaded Nexplanon applicator is removed from its packaging, and the transparent protection cap is removed to reveal the needle and implant. The skin is stretched, and the needle is inserted at a 30-degree angle. Once the needle is under the skin, the angle is lowered to be parallel to the skin surface. The needle is advanced to its full length without applying pressure to the purple slider. The purple slider is then unlocked by pushing it slightly down and fully slid back until it stops, leaving the implant in place subdermally. The applicator is removed, and the insertion site is closed with a sterile adhesive bandage. Proper placement should be verified by palpation immediately after insertion.
Key Considerations for Insertion Timing
- The implant can be inserted at any time if it is reasonably certain that the woman is not pregnant 1.
- If the implant is inserted within the first 5 days since menstrual bleeding started, no additional contraceptive protection is needed 2.
- If the implant is inserted more than 5 days since menstrual bleeding started, the woman needs to abstain from sexual intercourse or use additional contraceptive protection for the next 7 days 2.
Post-Insertion Care and Follow-Up
- Patients should be advised about possible side effects including irregular bleeding, headache, and mood changes.
- The implant provides contraception for up to 3 years and works by releasing etonogestrel to prevent ovulation.
- A follow-up appointment should be scheduled to check for proper placement and to address any concerns or side effects.
Special Considerations for Switching from Another Contraceptive Method
- If switching from an IUD, the healthcare provider may consider advising the woman to retain the IUD for at least 7 days after the implant is inserted and return for IUD removal, or to abstain from sexual intercourse or use barrier contraception for 7 days before removing the IUD and switching to the new method 3.
From the Research
Insertion Instructions for Nexplanon (Etonogestrel)
- The Nexplanon implant should be inserted by a trained healthcare provider as an office-based procedure 4.
- The implant is typically inserted on the medial side of the non-dominant upper arm 5.
- Healthcare providers must be trained on Nexplanon before performing insertions or removals of the implant 4, 6.
- The most common adverse reaction to Nexplanon insertion is a change in menstrual bleeding patterns 4.
- Incorrect insertion, such as initially unrecognized non-insertion, partial insertion, or deep insertion, can occur, with an incidence of 12.6 per 1000 insertions 6.
Removal Instructions for Nexplanon (Etonogestrel)
- The Nexplanon implant should be removed by the end of the third year of use 4.
- Removal of the implant is typically performed as an office-based procedure 4, 6.
- If the implant is palpable and located in subcutaneous tissue, it can be removed with a small skin incision, without the need for imaging 5.
- If the implant is not palpable, imaging techniques such as ultrasound, X-ray, or MRI may be used for precise localization 5, 7.
- Near-infrared light can also be used as an alternative method to locate nonpalpable etonogestrel implants 7.
- The most common challenge reported by healthcare providers during implant removal is encasement of the implant within fibrotic tissue 6.