1. Contraceptive Implants Session IV A: One-Rod Implant Insertion

2. One-Rod Implant Insertion: Required Equipment
An examination table
Sterile surgical drapes (optional) and gloves
Antiseptic solution
Local anesthetic, needles, and syringe
Implanon NXT applicator
Skin closure, sterile gauze, and compresses
Instructions for facilitator:
Use the illustration and the information on the slide to describe the equipment required for the insertion procedure.
Implanon NXT is the only one-rod system currently on the market. Similar to two-rod implants, Implanon NXT is inserted sub-dermally.
The basis for the successful use and subsequent removal of a one-rod implant is a correct and carefully performed sub-dermal insertion. The provider should give special attention to aseptic technique and careful surgical technique to minimize tissue trauma and to keep the implant from being inserted too deeply, thus becoming more difficult to remove.
Providers with little experience in sub-dermal insertion should acquire the correct technique under the supervision of an experienced colleague.
Illustration is adapted from: Prescribing Information: Norplant® II Levonorgestrel Implants (Jadelle®), NDA , Supplement 003/Population Council.

3. Implanon NXT Applicator
Instructions for facilitator:
Use the illustration on the slide and the information below to describe individual components of the applicator and clarify their specific functions.
Explain that insertion of Implanon NXT is performed with the specially designed applicator
The Implanon NXT insertion procedure is opposite to giving an injection. When inserting Implanon NXT, the obturator must remain fixed while the cannula (needle) is retracted from the arm. For injections, the plunger is pushed and the body of the syringe remains fixed.

4. Implanon NXT Insertion: Step 1
Have the client lie on her back with the arm that she doesn’t normally use flexed at the elbow and externally rotated.
Implanon NXT should be inserted sub-dermally just under the skin.
Use the illustrations and the information on the slide to describe each step in the insertion procedure.
Pictures from Implanon NXT Global Training Package

5. Implanon NXT Insertion: Step 2
Mark the insertion site with a marker.
Make 2 marks:
First, mark the spot where the rod will be inserted.
Second, mark a spot a few centimeters proximal to the first mark. This second mark will later serve as a direction guide during insertion.
Use the illustration and the information on the slide to describe this step in the insertion procedure.
Pictures from Implanon NXT Global Training Package

6. Implanon NXT Insertion: Step 4
Clean the client’s upper arm with antiseptic solution.
Anesthetize the insertion area with anesthetic spray or by injecting 2 cc of 1% lidocaine just under the skin along the planned insertion tunnel).
Use the illustration and the information on the slide to describe this step in the insertion procedure.

7. Implanon NXT Insertion: Step 5
Remove the sterile preloaded disposable Implanon NXT applicator from the blister pack
Hold the applicator just above the needle at the textured surface area and remove the transparent protection cap by sliding it horizontally away from the needle
You should be able to see the white implant by looking into the tip of the needle
Do not touch the purple slider until you have fully inserted the needle subcutaneously, as it will retract the needle and release the implant from the applicator.
Use the illustration and the information on the slide to describe this step in the insertion procedure
Remind providers that the needle and the implant must be kept sterile. If contamination occurs, a new package with a new sterile applicator must be used.
Discuss that you can best see movement of the needle if you are seated and are looking at the applicator from the side and not from above. In this position, you can clearly see the insertion site and the movement of the needle just under the skin.
Pictures from Implanon NXT Global Training Package

8. Implanon NXT Insertion: Step 6
Stretch the skin around the insertion site with thumb and index finger.
Insert the tip of the needle, at slightly less than a 30 degree angle.
Lower the applicator to a horizontal position
While lifting the skin with the tip of the needle, slide the needle to its full length
Use the illustration and the information on the slide to describe this step in the insertion procedure
Remind providers that the implant can fall out of the needle prior to insertion. Instruct them to always hold the applicator with the needle pointed upwards, until the time of insertion. This will prevent the implant from dropping out. The needle and the implant must be kept sterile. If contamination occurs, a new package with a new sterile applicator must be used.
Remind providers that:
-During the entire insertion procedure you should be able to see the insertion site and the movement of the needle
-The provider may feel slight resistance but do not exert excessive force.
-If the needle is not inserted to its full length, the implant will not be inserted properly. If partial protrusion occurs, discard the implant and reinsert a new sterile implant using a new applicator
Pictures from Implanon NXT Global Training Package

9. Implanon NXT Insertion: Step 7
While keeping applicator in the same position and the needle inserted to its full length, unlock the purple slider by pushing it slightly down
Move the slider fully back until it stops, leaving the implant in its final position and locking the needle inside the body of the applicator
Remove the applicator
Use the illustration and the information on the slide to describe this step In the insertion procedure
Pictures from Implanon NXT Global Training Package

10. Implanon NXT Insertion: Step 13
Verify the presence of the implant by palpating the site.
Have the woman palpate the implant
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.
Fill out the user card and give it to the client.
Review post-insertion instructions and other key messages.
Dispose of the applicator and syringe properly.
Use the illustration and the information on the slide to describe this step in the insertion procedure
Always verify the presence of the implant by palpation and also have the woman palpate it herself.
Apply a sterile gauze with a pressure bandage to prevent bruising. Discuss that the woman may remove the pressure bandage after 24 hours and the small bandage after 3-5 days.
Complete the user card and give it to the client. Explain that the user card records the batch number of the implant, the date of insertion, the arm of insertion, and the intended day of removal.
Review the post-insertion instructions and key messages for implant users, and address any final questions that the client may have. (See basic presentation slide set III for details).
Dispose of the applicator and syringe properly. The applicator is for single use only and must be disposed of in a sharps container in accordance with local regulations for the handling of biohazardous waste.
llustration adapted from: Prescribing Information: Norplant® II Levonorgestrel Implants (Jadelle®), NDA , Supplement 003/Population Council.