Inserting Implants

Explaining the Insertion Procedure

A woman who has chosen implants needs to know what will happen during insertion. The following description can help explain the procedure to her. Learning to insert and remove implants requires training and practice under direct supervision. Inserting implants usually takes only a few minutes but can sometimes take longer, depending on the skill of the provider. Related complications are rare and also depend on the skill of the provider.

Insertion Procedure for 1-Rod Implants – Implanon NXT (Nexplanon)

The provider should ensure that the essential equipment, supplies, and the implant itself are available (see below).

The provider should use proper infection-prevention practices throughout the procedure.

implant supplies

Steps for the Insertion Procedure for 1-Rod Implants
1
  • Place a clean, dry cloth under the woman’s arm and position the non-dominant arm with elbow flexed and hand behind ear.
  • Mark position on arm for insertion of rod, 8–10 cm from the medial epicondyle and 3–5 cm below the sulcus.
 Mark position on arm for insertion of rod
2
  • Prep insertion site with antiseptic solution and drape.
  • Inject 1–2 mL of 1% lidocaine just under the skin, raising a wheal at the insertion point and advancing up to 5 cm along the insertion track.
 Prep insertion site
3
  • Using the no-touch technique, remove the sterile disposable 1-rod applicator from blister pack. Hold it at the textured surface area. Visually verify presence of implant inside of needle. Remove needle shield.
 Reviewing implant applicator
4
  • Provider should be situated to visualize the insertion and ensure it is subcutaneous and parallel to the arm.
  • Stretch skin near insertion site with thumb and index finger. Puncture skin with applicator at a 30º angle and insert only the bevel of the needle.

hello world

Insertion of implant Insertion of implant
5

  • Visualizing the needle, lower the applicator until parallel with surface of skin and gently advance, while lifting skin upwards to ensure superficial placement.

Holding applicator
  • Insert entire length of the needle without using force. Verify entire length of the needle has been inserted in the skin before the next step.

Insert needle

 
6
  • Hold the applicator in this position and press the purple slider downwards until it stops.

Hold applicator

 
  • This action will retract the needle into the body of the applicator.

Retract the needle
7
  • Gently remove applicator, leaving the implant in place.
 Remove applicator
8
  • Palpate to check the implant is in place. Ask the woman to palpate the implant to confirm its presence.
 Comfirm implant
9
  • Close the incision site with a sterile skin closure.
 Close insertion
10
  • Apply pressure bandage dressing to minimize bleeding and bruising.
 Apply bandage

 

Insertion Procedure for 2-Rod Implants – Jadelle and Levoplant

The provider should ensure that the essential equipment, supplies, and the implant itself are available (see below). The provider should use proper infection-prevention practices throughout the procedure.

2 rob supplies

Steps for the Insertion Procedure for 2-Rod Implants
1
  • Place a clean, dry cloth under the woman’s arm and position the non-dominant arm with elbow flexed and hand parallel to ear.
  • Mark positions (A) and (B) on arm for insertion of rods, 6–8 cm above the medial epicondyle
 Position on arm for insertion of rod
2
  • Prep insertion site with antiseptic solution and drape.
  • Inject 1–2 mL of 1% lidocaine just under the skin raising a wheal at the insertion point and advancing up to 5 cm along the insertion tracks (A&B).
 Prep insertion site
3
  • Stretch skin near insertion site with thumb and index finger.
  • Puncture skin with trocar at a 20º angle and insert only the bevel of the needle.
 Reviewing implant applicatorReviewing implant applicator

 
4
  • Lower the applicator until parallel with surface of the skin and gently advance, while lifting skin upwards to ensure superficial placement.

Lower the applicator
  • Advance trocar and plunger to mark (1) nearest the hub of the trocar.

Insertion of implant
5

  • Remove plunger while holding trocar in place.

Holding trocar in place
  • Load first rod (A) into trocar with tissue forceps.

Load first rod

 
6
  • Reinsert plunger, advancing until resistance is felt.
 Remove the plunger while holding trocar in place

 
7
  • Hold plunger firmly in place with one hand, and slide the trocar out of the incision until it reaches the plunger handle.

Hold plunger firmly

 
  • Withdraw trocar and plunger together until mark (2) nearest the trocar tip (do not remove the trocar from the incision).

Retract the needle
8
  • At mark (2), redirect the trocar about 15º away from the first rod inserted (A). Advance trocar and plunger toward (B) up to mark (1) and insert second rod (B) using the same technique (repeat steps 5–7).
 Implation
9
  • Palpate to check the implants are in place. Ask the woman to palpate the implants to confirm their presence.
 Comfirm implant
10
  • Close the incision site with a sterile skin closure.
 Close insertion
11
  • Apply pressure bandage dressing to minimize bleeding and bruising.
 Apply bandage

 

Advice for the Client After Inserting Implants

Give Specific Instructions

Keep arm dry
  • The user should keep the insertion area dry for 4 days. She can take off the gauze after 2 days and the adhesive bandage and surgical tape when the incision heals, usually after 3–5 days.
Expect soreness, bruising
  • After the anesthetic wears off, her arm may be sore for a few days. She also may have swelling and bruising at the insertion site. This is common and will go away without treatment.
Length of pregnancy protection
  • Explain that it is important to have implants removed before they start to lose effectiveness. At that time, she can have a new set of implants inserted if she wants.
  • Discuss how to remember the date to return for implant removal and possible replacement.
  • Give each woman the following information in writing on a reminder card, like the one shown below, if possible, and explain:
    • the type of implant she has and in which arm
    • the date of insertion
    • the month and year when implants will need to be removed or replaced
    • where to go if she has problems or questions about her implants.

implant reminder card