The practitioner should have the following available for the office procedure:
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Sterile gloves
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Disposable sterile implant applicator
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Local injectable anesthetic, such as 1% lidocaine with or without epinephrine
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2-mL syringe
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Needle (18 gauge) for drawing up the anesthetic
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Needle (25 gauge, 1.5 cm) for injecting the anesthetic
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Antiseptic solution such as povidone iodine or chlorhexidine
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A sterile marking pen, if desired
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Adhesive dressing, such as Steri-Strips
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Pressure dressing, like Kerlix
Nexplanon is manufactured by Merck and had been distributed since about 2012. Its first-generation model, the Implanon, became available in the United States in 2006. [4] The implant is a single-rod nonbiodegradable device that measures 4 cm in length and 2 mm in diameter. It contains a core of 68-mg etonogestrel (3-ketodesogestrel), which is the biologically active metabolite of desogestrel. The rod is made of the plastic ethylene vinyl acetate (EVA) copolymer covered by a thin EVA membrane that slowly releases hormone over 3 years.
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Patient's wrist is parallel to her ear or her hand is positioned next to her head.
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The insertion site, which is at the inner side of the nondominant upper arm about 8cm above the medial epicondyle of the humerus.
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The transparent protection cap should be removed by sliding it horizontally away from the device.
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With your free hand, use countertraction on the skin as you insert the needle at a 30 degree angle.
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Once the needle has punctured the skin, hold the applicator horizontal to the skin, and tent the skin upwards as you slide the entirety of the needle into the subdermal space.
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While holding the applicator in place, unlock the purple slider with your index finger by pushing the slider downwards and backwards until it locks.
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At this point the needle is inside the applicator and the applicator can be removed from the field.
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The practitioner and patient should palpate the implant immediately after insertion.
