Nexplanon Insertion

Nexplanon Insertion Opener

This module describes how to insert the Nexplanon contraceptive implant.


  1. Contraception for up to 3 years


  1. Current pregnancy

  2. Current/past thrombosis or thromboembolism

  3. Liver tumours or active liver disease

  4. Undiagnosed abnormal vaginal bleeding

  5. Current/former breast cancer or other progestin-sensitive tumours

  6. Allergy to any component of Nexplanon


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.”


Insertion may be

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.

Nexplanon Insertion Equipment

Documentation

  1. Patient notes

Equipment

  1. Sterile gloves

  2. Alcohol-based hand rub

  3. Swabs/cotton balls

  4. Sterile pack

  5. 3 ml syringe

  6. Blunt fill needle & 20-22 G needle

  7. Lignocaine

  8. Alcohol swab

  9. Transparent film dressing and gauze

  10. Nexplanon in sterile package


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

between the biceps and triceps. Insert the implant from this point subdermally towards the axilla, parallel to the triceps.


Follow medical asepsis with sterile gloves.

  1. Perform hand hygiene.

  2. Draw up 2 ml lignocaine and inject it into the insertion site and along the insertion tract.

  3. Open the sterile pack and create a sterile field on a clean, dry surface. Pour disinfectant into the well containing cotton balls. Open the Nexplanon onto the sterile field.

  4. Perform hand hygiene and don sterile gloves.

  5. and drape the site.

  6. Remove the plastic shield from the Nexplanon applicator needle.

  7. Stretch the skin towards the elbow with your non-dominant hand.

  8. Insert the needle until the bevel is just under the skin surface

    .

  9. Angle the applicator parallel to the skin and advance to the hub, with the needle tip tracking just below the skin surface.

    with the applicator and needle to ensure superficial insertion.

  10. Holding the applicator steady and without retracting,

    all the way down.

  11. Remove the applicator.

  12. Apply a gauze pad and transparent film dressing.

  13. Palpate the implant and request the patient to do the same to confirm placement.

  14. Dispose of medical waste safely.

  15. Document the completion of the procedure. Complete the user card for the patient to keep. Attach the chart label to the patient’s notes.


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.


  1. Deep insertion: difficult or impossible removal

  2. Bruising, minor bleeding, local pain and irritation

  3. Scarring

  4. Abscess formation or local infection

  5. Sharps injury to healthcare personnel

  6. Implant expulsion

  7. Implant migration

  8. Risk of adverse events related to the Nexplanon implant


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