Contraceptive Implant Procedures: Implanon^®

Prepared for OBGYN residents
at the St. Paul Hospital Millennium Medical College,
Addis Ababa, Ethiopia

Insertion Procedure

During Appointment for Procedure: Getting Ready

• Step 1: Check to be sure the patent has washed her entire arm with soap and water.
• Step 2: Help position the patient on the table.
• Step 3: Place a clean, dry cloth under her arm.
• Step 4: Determine and mark the optimal insertion area.
• Step 5: Prepare an instrument tray and open the sterile instrument pack or high-level disinfected container without touching the instruments and other items. The sterile instruments, facilities and supplies necessary for insertion and removal of Implanon is similar to that of Jadelle^®, which is another type of hormonal implant.
• Step 6: Wash your hands thoroughly with soap & water and dry them.
• Step 7: Put sterile surgical gloves on both hands.
• Step 8: Arrange instruments and supplies so that they are easily accessible.
• Step 9: Apply iodine solution to the incision area two times.
• Step 10: If a sterile surgical drape with a hole in it is available, it should be used to cover the arm.
• Step 11: Anaesthetize with 1ml of 1% lidocaine applied just under the skin along the insertion area: Raise a small wheal in skin entry. Advance needle to its full length (about 5 cm) directly under the skin and inject 1 ml of local anesthetic. If an iodophor (e.g., Betadine) is used, allow to air dry for about 2 minutes before proceeding. Begin by wiping at the insertion site and move outward in a circular motion for 8 to 13 cm (3 to 5 inches).

During Appointment for Procedure: Inserting the rods

1. Remove the sterile disposable applicator carrying Implanon‚ from its blister and remove the needle shield.
2. Always hold the applicator in the upward position. This to prevent the implant from dropping out.
3. Visually verify the presence of the implant
4. Stretch the skin around the insertion site with thumb and index finger
5. Insert only the tip of the needle, slightly angled (~ 20°)
6. Release the skin.
7. Lower the applicator to a horizontal position.
8. Lift the skin with the tip of the needle, but keep the needle in the sub dermal connective tissue
9. Gently insert, while lifting the skin, the needle to its full length without using force.
10. Keep the applicator parallel to the surface of the skin.
11. When the implant is placed too deeply the removal can be hampered later on.
12. Break the seal of the applicator.
13. Turn the obturator 90°
14. Fix the obturator with one hand against the arm and with the other hand slowly retract the cannula (needle) out of the arm. Never push against the obturator.
15. Check the needle for the absence of the implant.
16. Do not confuse the protruding end of the obturator with the implant (same color).
17. Always verify the presence of the implant by palpation
18. Apply sterile gauze with a pressure bandage to prevent bruising.
19. Bring the edges of the incision together and use a Band-Aid or surgical tape
20. Check for any bleeding
21. Before removing gloves, put the applicator and syringe and needle in to sharps container
22. Place all contaminated objects in a properly marked, leak-proof container. The applicator is for single use only and must be adequately disposed of, in accordance with local regulations for the handling of biohazardous waste.
23. Place the drape in a dry covered container and remove to the designated washing area
24. Immerse both gloved hands in 0.5% chlorine solution.
25. If disposing of gloves, place in a leak-proof container or plastic bag
26. Fill out the User Card and hand it over to the client to facilitate removal of the implant later on.
27. Place a note in the client's record indicating the location of the rod and specifying any unusual events that may have occurred during insertion.
28. Instruct client regarding wound care (see below) and make a return visit appointment, if needed.
29. Wash hands thoroughly with soap and water and dry with a clean, dry cloth or air dry.
30. Observe the client for at least 15 to 20 minutes. Check for Client instructions for insertion site.

Key points about the insertion procedure

• Insert Implanon at the correct time in accordance with the information in the package insert.
• Visually check the presence of the implant inside the needle prior to insertion.
• Keep the applicator upright after removing the cap.
• Always follow the insertion procedure as described in the package insert.
• Check if the needle is empty after insertion.
• Always palpate the implant immediately after insertion.

Patient instructions for wound care

• Keep the insertion area dry and clean for at least 48 hours (2 days).
• Leave the gauze pressure bandage in place for 48 hours.
• Leave the smaller bandage/dressing under the gauze pressure bandage in place until the incision heals (approximately 3-5 days).
• Bruising, swelling, or tenderness at the insertion site may occur for a few days- this is normal.
• Routine work can be done immediately but avoid bumping the area, carrying heavy loads, or putting unusual pressure to the site.
• After healing, the area can be touched and washed with normal pressure.
• If the incision site becomes inflamed (red with increased heat or tenderness) or there is pus at the site, return to the health facility.