1. Session IV B, Slide #1 Contraceptive Implants Session IV B: One-Rod Implant Removal

2. Session IV B, Slide #2 Implanon Removal: Required Equipment An examination table Sterile surgical drapes and gloves Antiseptic solution Local anesthetic, needles, and syringe Sterile scalpel, forceps (straight and curved mosquito) Skin closure, sterile gauze and compresses

3. Session IV B, Slide #3 Implanon Removal: Step 1 Have the client lie on her back with her arm flexed at the elbow. Locate the implant by palpitation and mark the distal end. Wash the area and apply a disinfectant.

4. Session IV B, Slide #4 Implanon Removal: Step 2 Anesthetize the arm with 0.5-1 ml of lidocaine (1%) at the site of the incision, which is just below the distal end of the implant.

5. Session IV B, Slide #5 Implanon Removal: Step 3 Push down the proximal tip of the implant; a bulge may appear indicating the distal end of the implant. Make an incision of 2 mm in length in the longitudinal direction of the arm at the distal end of the implant.

6. Session IV B, Slide #6 Implanon Removal: Step 4 Gently push the implant toward the incision until the tip is visible. Grasp the implant with mosquito forceps and remove it.

7. Session IV B, Slide #7 Implanon Removal: Step 5 If the tip of the implant is not visible, fibrotic tissue might have formed around the implant. The fibrotic tissue can be split by continuing to cut toward the distal tip until the tip is clearly visible. Remove the implant with forceps.

8. Session IV B, Slide #8 Implanon Removal: Step 6 If the tip of the implant is still not visible, gently insert a forceps into the incision and grasp the implant. With a second forceps, carefully dissect the tissue around the implant. The implant can then be removed.

9. Session IV B, Slide #9 Implanon Removal: Step 7 Close the incision with a skin closure. 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. Review post-removal instructions and other key messages. Clean or dispose of the instruments properly.

10. Session IV B, Slide #10 Post-removal Options If the woman decided to keep using this method and is still eligible, insert a new implant through the same incision, or if the client prefers, use the other arm. If the woman decided to discontinue using the implant and does not want to become pregnant, counsel her about other contraceptive options.