Nexplanon Removal

Nexplanon Removal Opener

This module describes how to remove a Nexplanon contraceptive implant.


  1. Patient request

  2. After 3 years of use


  1. Impalpable implant (see Troubleshooting)


Always verify your patient’s identity and obtain informed consent before proceeding.

How do I explain this procedure?

“You are ready for the removal of your Nexplanon implant. This is a short and simple procedure with minimal discomfort.”

What can my patient expect?

“I will give you an injection for pain first. I will make a small cut where the implant is, and then I’ll pull it out with tweezers.”

What is my patient’s role?

“Keep still with your hand behind your head while I remove the implant. Fearing blood or needles is normal, but tell me if you have fainted from it. Let me know if you have any pain.”


Prepare a trolley with equipment.

Nexplanon removal Equipment

Documentation

  1. Patient notes

Equipment

  1. Sterile gloves

  2. Alcohol-based hand rub

  3. Swabs/cotton balls

  4. Sterile suture pack

  5. Scalpel blade

  6. 3 ml syringe

  7. Blunt fill needle & smallest gauge needle available

  8. Lignocaine

  9. Alcohol swab

  10. Transparent film dressing and gauze


Position the patient with their arm (containing the implant) flexed, and the hand behind their head. Palpate the arm to locate the extraction site, usually 8-10 cm proximal to the medial epicondyle and 3-5 cm inferior, overlying the triceps. On depressing the proximal end of the implant, the distal end should pop up under the skin.


Follow medical asepsis with sterile gloves.

  1. Perform hand hygiene.

  2. Draw up 2 ml lignocaine and anaesthetise the site.

  3. Open the sterile pack and create a sterile field. Pour disinfectant into the well. Open the scalpel blade onto the field.

  4. Perform hand hygiene and don sterile gloves.

  5. and drape the site.

  6. Depress the proximal end of the implant so that the distal end becomes visible under the skin.

  7. Make a small, longitudinal

    at the distal end of the implant.

  8. The tip of the implant should pop out. Otherwise, gently push it towards the incision until it becomes visible. You may need to bluntly dissect adherent tissue until the tip becomes visible.

  9. Grip the tip with mosquito forceps and extract the implant.

  10. Confirm that the entire 4 cm rod has been removed intact.

  11. Apply a gauze pad and transparent film dressing.

  12. Dispose of medical waste safely.

  13. Document the completion of the procedure.


I can’t palpate the implant OR I can’t remove it.

Stop and refer the patient to a provider experienced in difficult removals.

After removal, I want to insert a second Nexplanon.

You can do this through the same incision.

I suspect I didn’t get the entire implant out.

These implants can sometimes break, resulting in incomplete removal. Refer the patient to a provider experienced in difficult removals.


  1. Bruising, minor bleeding, local pain and irritation

  2. Scarring

  3. Abscess formation or local infection

  4. Sharps injury to healthcare personnel


  1. Nexplanon Prescribing Information. Organon USA LLC. 2021.