What are the steps to set up a Nexplanon (etonogestrel implant) tray for insertion?

Setting Up a Nexplanon Tray for Insertion

To properly set up a Nexplanon (etonogestrel implant) tray for insertion, follow these specific steps to ensure a safe and effective procedure.

Preparation of Materials

• Verify that you have the Nexplanon applicator package containing the sterile disposable applicator preloaded with the single implant 1
• Ensure the following additional items are available:
  • Clean examination table for the patient to lie on 2
  • Sterile surgical drapes to create a sterile field 2
  • Sterile gloves for the provider 2
  • Antiseptic solution (such as chlorhexidine) for skin preparation 2
  • Local anesthetic (1-2% lidocaine with or without epinephrine) 1
  • Sterile gauze 2
  • Sterile adhesive bandage and pressure bandage 2
  • Surgical marker to mark insertion site 2

Anatomical Considerations for Safe Insertion

• Identify the proper insertion site on the inner side of the non-dominant upper arm about 8-10 cm above the medial epicondyle of the humerus 3
• Avoid insertion near the sulcus (groove) between the biceps and triceps muscles to prevent nerve injury 3
• Mark the insertion site and the path of insertion with a surgical marker 2
• Position the patient's arm with elbow flexed and hand positioned under the head (or as directed in current insertion instructions) 2

Procedural Setup

• Open the sterile package containing the Nexplanon applicator only when ready to perform the insertion 2
• Verify the presence of the implant in the needle by looking at the transparent chamber of the applicator 2
• Prepare the insertion site using antiseptic solution in a circular motion for at least 30 seconds 2
• Draw up local anesthetic in a syringe with a small gauge needle for administration at the insertion site 1

Critical Safety Considerations

• Always complete the Nexplanon clinical training program before attempting insertion 1, 2
• Be familiar with the proper insertion technique to avoid complications such as deep insertion or nerve injury 3
• Understand that incorrect insertion (non-insertion, partial insertion, or deep insertion) occurs at a rate of approximately 12.6 per 1000 insertions 2
• Be aware of the potential for rare complications such as nerve injury, which can cause forearm pain and hypoesthesia 3

Post-Insertion Setup

• Prepare a pressure bandage to apply over the insertion site after the procedure 2
• Have patient education materials ready regarding expected side effects, particularly changes in menstrual bleeding patterns 1
• Document the procedure, including lot number and expiration date of the implant 2

Common Pitfalls to Avoid

• Failure to properly identify anatomical landmarks can lead to nerve injury or deep insertion 3
• Incorrect insertion technique may result in non-insertion, partial insertion, or deep insertion 2
• Improper sterile technique can lead to infection at the insertion site 2
• Insertion too deep can make removal difficult due to encasement of the implant in fibrotic tissue 2

Remember that proper training is essential before performing Nexplanon insertions, and all healthcare providers must complete the required clinical training program to minimize procedure-related complications 1, 2.