Implanon NXT

Last updated 13.02.13

   

Definition

-  Long term subcutaneous progesterone contraceptive device

 

Implanon

 

-  Insertion

-  Removal

-  Lost device

 

Features

-  Small device inserted subcutaneously usually in arm

-  +/- requires cover w 7/7 safe sex post insertion

-  Requires training to insert (2hr course)

-  Etonogestrel (Progesterone)

-  0.01-0.06% failure rate

-  3 yr PEARL index 0.00

-  3 years efficacy then removed

-  Subsidised in Australia

-  Comes preloaded in sterile, disposable container

-  Mechanism: inhibition of ovulation

-  Once removed fertility immediately reverts to previous level

-  Radiopaque

 

Indications

-  Contraception

-  Suitable for use >4/52 post partum

-  Does not effect production or quality of breast milk

-  No evidence for effect on growth or development but warrants monitoring

 

Contraindications

-  Active DVT, PE

-  Liver Ca/tumour

-  Severe liver disease

-  Undiagnosed vaginal bleeding

-  Pregnancy

 

Side Effects

-  Pregnancy

-  Implanon should be removed once aware

-  May cause masculinisation of female fetus

-  Irregular bleeding/Amenorrhoea

-  Less or more frequent, continuous

-  Reduced or increased volume

-  Increased or decreased duration

-  Acne

-  Breast tenderness

-  Depression

-  Weight gain

 

 

Implanon Insertion

 

Definition

-  Insertion of Implanon subcutaneous contraceptive device

 

Features

-  Once inserted may migrate deeper into tissue

-  Inserted from 1st day of menstrual period to day 5

-  Should practice contraception for 7/7+ post insertion to ensure no unwanted pregnancy

 

Equipment

-  Implanon insertion device

-  Sterile + non sterile gloves

-  Betadine prep, tray & sterile gauze

-  LA: Lidocaine 1% +/- Adrenaline

-  5ml Syringe

-  20G needle

-  Bandaid

-  Opsite

-  Bandage  

 

Procedure

- Explanation & consent

-  Patient supine

-  Shoulder abducted, externally rotated, arm flexed

-  Confirm site

-  8-10cm prox to cubital fossa between biceps brachialis & triceps brachi on medial surface of arm

-  Inject LA along planned insertion site

-  Implanon insertion device inserted from distal to proximal

-  As superficial as possible

-  Once in position, 1cm+/- from hilt pull tab & twist to release Implanon

-  Palpate to confirm location

-  Confirm with patient location & size of Implanon

-  Give patient card with details: position, date of insertion & removal

-  Bandaid + tegederm (waterproof) + bandage (bleeding)

-  Keep dry then remove pressure dressing after 24hrs

-  +/- cover with alterative method for 7 days

-  R/V of site in 7/7: infection, migration

 

Insertion

 

 

 

 

Implanon Removal

 

Definition

-  Removal +/- reinsertion of Implanon subcutaneous contraceptive device

 

Features

-  Removal of contraceptive Implanon device

-  Main reasons for removal

-  3yrs (expiry)

-  No longer required: desire for pregnancy, post menopausal..

-  Abnormal menstrual bleeding

-  Depression

-  Weight gain

-  If LA at incision site wo anchor first often tissue induration obscures Implanon

-  Expect a reasonable amount of blood from incision

 

Equipment

-  Sterile gloves

-  Betadine prep

-  Sterile tray

-  Gauze

-  +/- sterile marker

-  LA: Lidocaine 1% +/- Adrenaline

-  5ml Syringe

-  20G needle

-  Scalpel

-  Forceps – Curved mosquito

-  Steristrips

-  +/- suture material

 

Procedure

-  If patient has card confirm arm & date for removal

- Explanation & consent

-  Patient supine

-  Arm adducted & externally rotated to expose medial aspect of upper arm

-  Confirm location & position of Implanon by palpation

-  Clean site with antiseptic

-  +/- mark incision site (distal end) with sterile marker

-  Infiltrate 0.5-1ml LA at incision site

-  Infiltrate under Implanon to avoid the bleb obscruring it

-  Push down proximal end to displace distal end into skin

-  Make incision with scalpel from distal tip 2mm+/- towards elbow

-  Parallel rather than perpidicular to Implanon

-  Push from proximal end to incision site

-  Grasp Implanon with curved mosquito forceps

-  Remove Implanon

-  May be encapsulated & require additional incision over capsule

-  Confirm entire rod (4cm) has been removed ie: measure

-  If pt requires another Implanon immediately reinsert into incision site

-  Steri strip to incision site + adehsive bandage

-  LA via insertion site along insertion canal

-  Sterile gauze then pressure bandage to reduce bruising

-  Keep dry then remove pressure bandage after 24hrs

-  Remove adhesive + steristrips after 3-5 days

 

Removal

 

 

Difficult Implanon Removals (alternative technique)

-  Patient supine

-  Mark site of Implanon as H

-  Along shaft, perpendicular at ends

-  LA at 2/3 & 1/3 along shaft (small blebs)

-  Insert 22G needle deep to body of Implanon as anchor

-  LA at incision site for removal

-  Perpendicular incision along end of H

-  Often capsule forms around Implanonwhich requires incision

-  Remove Implanon

 

Removal

 

Implanon Not Palpable

-  Either Implanon too deep or not present

-  Use alternative contraception until issue resolved

-  Imaging

-  US with high frequency transducer (10mhz+)

-  +/- plain film x-ray (radio-opaque)

-  +/- MRI

-  If not seen on imaging: progesterone levels

-  If seen consider removal w US guidance

 

 

 

References

 

Pic: www.anticonceptie-online.nl/implanon/implan1.jpg

Pics (insertion & removal): www.medicines.ie/medicine/14810/SPC/Implanon+NXT/