Nexplanon insertion. A sterile pen marks the insertion site, which is 8 to 10 cm proximal to the medial humeral condyle. A second mark is placed 4 cm proximally along the arm’s long axis. The area is cleaned aseptically, and a 1-percent lidocaine anesthetic track is injected along the planned insertion path. A. The insertion device is grasped at its gripper bubbles found on either side, and the needle cap is removed outward. The device can be seen within the needle bore. The needle bevel then pierces the skin at a 30-degree angle. B. Once the complete bevel is subcutaneous, the needle is quickly angled downward to lie horizontally. C. Importantly, the skin is tented upward by the needle as the needle is slowly advanced horizontally and subdermally. D. Once the needle is completely inserted, the lever on the top of the device is pulled backward toward the operator. This retracts the needle and thereby deposits the implant. The device is then lifted away from the skin. After placement, both patient and operator should palpate the 4-cm implant. Source: Contraception, Williams Obstetrics, 25e Citation: Cunningham F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS. Williams Obstetrics, 25e; 2016 Available at: http://obgyn.mhmedical.com/DownloadImage.aspx?image=/data/books/1918/cunnwo25-ch038_f004.png&sec=154773941&BookID=1918&ChapterSecID=154773872&imagename= Accessed: October 24, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved