Session 4 b

1. Session 4 B, Slide 1
Contraceptive Implants
Session 4 B:
One-Rod Implant Removal

2. Session 4 B, Slide 2
Nexplanon Removal:
Required Equipment
• An examination table
• Sterile surgical drapes
and gloves
• Antiseptic solution
• Local anesthetic, needles,
and syringe
• Sterile scalpel, forceps
(straight and curved
mosquito)
• Skin closure, sterile gauze
and compresses

3. Session 4 B, Slide 3
Nexplanon Removal: Step 1
• Have the client lie on her
back with her arm flexed
at the elbow.
• Locate the implant by
palpitation and mark the
distal end.
• Wash the area and
apply a disinfectant.

4. Session 4 B, Slide 4
Nexplanon Removal: Step 2
• Anesthetize the arm
with 0.5-1 ml of
lidocaine (1%) at the
site of the incision,
which is just below
the distal end of the
implant.

5. Session 4 B, Slide 5
Nexplanon Removal: Step 3
• Push down the proximal
tip of the implant; a bulge
may appear indicating the
distal end of the implant.
• Make an incision of
2 mm in length in the
longitudinal direction of
the arm at the distal end
of the implant.

6. Session 4 B, Slide 6
Nexplanon Removal: Step 4
• Gently push the implant
toward the incision until
the tip is visible.
• Grasp the implant with
mosquito forceps and
remove it.

7. Session 4 B, Slide 7
Nexplanon Removal: Step 5
• If the tip of the implant is
not visible, fibrotic tissue
might have formed around
the implant. The fibrotic
tissue can be split by
continuing to cut toward
the distal tip until the tip is
clearly visible.
• Remove the implant with
forceps.

8. Session 4 B, Slide 8
Nexplanon Removal: Step 6
• If the tip of the implant is still not visible, gently insert
a forceps into the incision and grasp the implant.
• With a second forceps, carefully dissect the tissue
around the implant.
• The implant can then be removed.

9. Session 4 B, Slide 9
Nexplanon Removal: Step 7
• Close the incision with a skin closure.
• Apply a sterile gauze and wrap the
arm with a pressure bandage.
• Before the client is discharged,
observe her for a few minutes for
signs of bleeding from the insertion
site.
• Review post-removal instructions
and other key messages.
• Clean or dispose of the instruments
properly.

10. Session 4 B, Slide 10
Post-removal Options
• If the woman decided to keep using this
method and is still eligible, insert a new implant
through the same incision, or if the client
prefers, use the other arm.
• If the woman decided to discontinue using the
implant and does not want to become
pregnant, counsel her about other
contraceptive options.