
Overview
This module describes how to insert the Nexplanon contraceptive implant.
Indications
Contraindications
Patient information and consent
Patients should be fully counselled about their contraceptive options. Always verify your patient’s identity and obtain informed consent before proceeding.
How do I explain this procedure?
“You have chosen the Nexplanon implant for family planning. I will insert the implant under the skin of your upper arm.”
What can my patient expect?
“I will give you an injection for pain first. The Nexplanon is a very small device which is stored in a needle. I will use the needle to inject the Nexplanon under your skin. After insertion, it should not be painful and there may be a small scar where I inserted the needle. The Nexplanon should not migrate to other sites in your body. You will be able to feel it as a flexible rod under your skin.”
What is my patient’s role?
“Tell me if you think you might be pregnant, or have any illnesses or allergies. Fearing blood or needles is normal, but tell me if you have fainted from it. If at any point you feel you do not want to continue with the procedure, tell me and I’ll stop immediately. Let me know if you feel faint or have any pain. Keep the dressing on for a day.”
Preparation
Insertion may be
timed with previous contraceptive use
COC: on the day after taking the last active tablet in the packet
Injectable: on the day the next injection is due
Minipill: within 24 hours of taking a tablet
Intrauterine device: on the day of removal
Post-partum: directly after delivery
or occur on days 1-5 of the menstrual cycle for immediate effectiveness. If deviating from these recommendations, barrier protection should be used for the first week after insertion.

Documentation
Equipment
Site & Positioning
Position the patient with the non-dominant arm flexed, the hand behind their head. The insertion site is 8-10 cm proximal to the medial epicondyle and 3-5 cm inferior, overlying the triceps and
avoiding the sulcus
Following reports of intravascular insertion and migration, the recommended insertion site is now inferior to the sulcus, overlying the triceps.
between the biceps and triceps. Insert the implant from this point subdermally towards the axilla, parallel to the triceps.
Procedure
Follow medical asepsis with sterile gloves.
Troubleshooting
I inserted the needle too deeply into the subcutaneous tissues.
Withdraw until just under the skin surface and reangle it. Try to lift the skin slightly with the needle tip as you advance.
I didn’t advance all the way before I retracted the slider AND/OR the implant is sticking out of the puncture site.
Remove and discard the implant and try again with a new applicator.
I broke the skin with the needle while I was advancing because I was trying to stay superficial.
Withdraw a little, reangle the needle slightly deeper and try again. As long as this wound does not gape open and the implant does not stick out of the skin, it should heal without consequence.