From the Guidelines
Nexplanon removal and insertion procedures are minor in-office procedures that can be performed by a trained healthcare provider, typically taking less than 5 minutes for removal and approximately 1 minute for insertion, with a high effectiveness rate of over 99% for up to 3 years 1. The procedures involve a healthcare provider locating the implant in the arm, cleaning the area, and injecting local anesthetic for removal, and using a special applicator to place the new Nexplanon subdermally for insertion.
- Key steps for removal include:
- Locating the implant in the arm
- Cleaning the area
- Injecting local anesthetic
- Making a small incision near the end of the implant
- Gently pushing the implant toward the incision and removing it with forceps
- Key steps for insertion include:
- Cleaning and numbing the inner upper arm
- Using a special applicator to place the new Nexplanon subdermally After the procedures, a pressure bandage is applied for 24 hours, followed by a smaller bandage for 3-5 days 1. It is essential to avoid strenuous activity for 24 hours and keep the area dry for 24-48 hours to minimize the risk of complications, which are rare but can include transient nerve injury and the need for removal under general anesthesia 1. The new Nexplanon implant provides immediate contraceptive protection if inserted immediately after removal, but if there's a delay, backup contraception is necessary 1.
From the Research
Nexplanon Removal and Insertion Procedures
- Nexplanon is a long-acting reversible contraceptive implant that is inserted subdermally and can be removed as an office-based procedure 2.
- The implant should be removed by the end of the third year of use, and persons will experience a rapid return to fertility once the implant is removed 2.
- All health care providers must be trained on Nexplanon before performing insertions or removals of the implant 2.
- The most common adverse reaction is a change in menstrual bleeding patterns 2.
Insertion Technique and Complications
- The importance of correct insertion technique is discussed, and care should be taken to avoid nerve injury during insertion of subdermal contraceptive implants 3.
- Nexplanon has a redesigned applicator intended to increase insertion accuracy 3.
- Improper insertion technique appears to be a key determinant in the risk for etonogestrel contraceptive implant migration 4.
Removal Procedures
- Removal of etonogestrel contraceptive implants can be done in the operating theater, especially for implants that are difficult to palpate or are impalpable 5.
- Preoperative ultrasound can localize the implant, and removal can be done under local anesthetic or general anesthesia 5.
- The removal of an implant that is not palpable or difficult to palpate should take place in the operating theater following localization by ultrasound 5.
- Patients must be fully informed about the procedure, including its complications and the risk for failure 5.
Migration and Complications
- Etonogestrel implant migration to the vasculature, chest wall, and distant body sites can occur, and awareness of migration and education on proper insertion technique may reduce the risk 4.
- Migration locations can include the lung/pulmonary artery, chest wall, vasculature, and other body sites, and symptoms can include pain, discomfort, and dyspnea 4.
- Surgical removal in an operating room setting may be necessary for cases of implant migration 4.
Clinical Practice and Management
- The use of long-acting reversible contraceptives, including subcutaneous implants, is increasing globally due to their higher ability to effectively prevent unintended pregnancies 6.
- Dedicated training is needed for the application of long-acting reversible contraceptives, and practical advice and technical tips for the ENG implant insertion/removal can be derived from clinical experience 6.
- Recommendations for the management of unscheduled bleeding during contraception with this method are available 6.