Should a pressure bandage be applied after Nexplanon removal?

Pressure Bandage After Nexplanon Removal

Apply a pressure bandage immediately after Nexplanon removal and maintain it for several hours to prevent hematoma formation and ensure hemostasis.

Immediate Post-Removal Management

The primary goal after Nexplanon removal is to achieve complete hemostasis and prevent hematoma formation, which can cause patient discomfort and complicate healing. 1

Standard Pressure Bandage Application

• Apply a pressure dressing immediately after implant removal using layered gauze pads directly over the insertion site, secured with an elastic adhesive bandage with sufficient tension to maintain hemostatic pressure. 2
• Maintain the pressure dressing for 12-24 hours to minimize hematoma formation while ensuring adequate hemostasis. 2, 3
• The pressure bandage serves to compress the subcutaneous tissue and prevent blood accumulation in the space left by the removed implant. 1

Technique for Optimal Hemostasis

• Before applying the pressure bandage, ensure direct manual pressure is applied to the removal site for at least 5-10 minutes without interruption. 2
• Layer multiple gauze pads over the wound to create adequate compression surface area. 2
• Apply the elastic bandage with enough tension to maintain pressure but not so tight as to occlude venous outflow, which could paradoxically worsen bleeding. 2

Special Considerations and Risk Factors

Anticoagulated Patients

Patients on anticoagulation require particular attention, as they are at significantly higher risk for severe hemorrhage and large hematoma formation after Nexplanon removal. 1

• A case report documented a patient on phenprocoumon (warfarin analog) who developed persistent bleeding and a large hematoma requiring blood transfusion (Hb drop from 8.1 to 5.0 mmol/L) after implant replacement despite pressure bandage application. 1
• In anticoagulated patients, consider applying topical thrombin in addition to the pressure dressing if direct pressure alone fails to achieve hemostasis. 2
• Never attempt needle aspiration of a hematoma, as this introduces skin flora and significantly increases infection risk. 2, 3

Deep or Difficult Removals

• Implants removed through larger incisions (>3mm) or those requiring more extensive dissection may benefit from extended pressure bandage duration (closer to 24 hours). 4
• Deep implants (>3mm depth) that require more manipulation during removal have higher bleeding risk and warrant more vigilant post-removal compression. 4

Post-Removal Instructions

Patient Education

• Instruct patients to keep the pressure bandage in place for the full recommended duration (12-24 hours) and avoid removing it prematurely. 2
• Advise patients to avoid heavy lifting or vigorous arm movement for 24 hours after removal to prevent disruption of hemostasis. 1
• Warn patients that some bruising is normal, but they should seek immediate care if they develop progressive swelling, severe pain, or signs of expanding hematoma. 1

Follow-Up Assessment

• After pressure bandage removal at 12-24 hours, inspect the site for signs of hematoma, continued bleeding, infection (erythema, warmth, purulent drainage), or skin complications. 5
• If a small hematoma has formed despite pressure bandaging, conservative management with observation is appropriate unless there is increased skin tension threatening wound integrity. 3

Common Pitfalls to Avoid

• Do not use transparent film dressings or simple adhesive bandages alone immediately after Nexplanon removal, as these do not provide adequate compression to prevent hematoma formation. 6 While these dressings are superior for vascular access sites after achieving hemostasis, they lack the compression needed for subcutaneous implant removal sites.
• Do not apply insufficient pressure thinking it will improve patient comfort—inadequate compression is the primary cause of post-removal hematomas. 2
• Do not skip the initial 5-10 minutes of direct manual pressure before applying the bandage, as this is critical for initial hemostasis. 2
• Avoid placing the pressure bandage so tightly that it occludes arterial flow or causes distal ischemia—the bandage should be snug but allow a finger to slip underneath. 5