Contraceptive Implants Session V A TwoRod Implant Insertion

Contraceptive Implants Session V A: Two-Rod Implant Insertion Session V A, Slide #1

Two-Rod Implant Insertion: Required Equipment • An examination table • Sterile surgical drapes and gloves • Antiseptic solution • Local anesthetic, needle and syringe • Disposable trocar • Tissue forceps • Skin closure, sterile gauze and compresses Session V A, Slide #2

Two-Rod Implant Insertion: Trocar and Rods The disposable trocar has two marks 1) The mark closest to the hub indicates how far the trocar should be introduced under the skin to place the rods. 2) The mark closest to the tip indicates how much of the trocar should remain under the skin following placement of the first rod. To get the sterile trocar and implant rods ready, open both packages carefully and allow trocar and rods to fall on a sterile drape/tray (no-touch technique). Session V A, Slide #3

Two-Rod Implant Insertion: Step 1 • Have the client lie on her back with her nondominant arm flexed at the elbow and externally rotated. • The implants will be inserted subdermally and positioned in a “V” shape. Session V A, Slide #4

Two-Rod Implant Insertion: Step 2 • Use the tissue forceps to hold a swab soaked with antiseptic solution • Apply antiseptic to clean the client’s upper arm • Frame the insertion area with a drape that has an opening. Session V A, Slide #5

Two-Rod Implant Insertion: Step 3 • Fill a syringe with 2 ml of a local anesthetic, such as lidocaine (1%). • Inject a very small amount of anesthetic to raise a small wheal at the puncture site • Advance the needle under the skin for 5 cm (2 inches) between where the two rods will be inserted • As you withdraw the needle, slowly inject 1 ml of anesthetic in a track Session V A, Slide #6

Two-Rod Implant Insertion: Step 4 • Puncture the skin with the trocar and insert its tip beneath the skin at a shallow angle • Gently insert the trocar while lifting the skin; failure to do so may result in deep placement of the rods and could make removal more difficult • Advance the trocar to the mark nearest the hub of the trocar. Session V A, Slide #7

Two-Rod Implant Insertion: Step 5 When the trocar has been inserted the appropriate distance, remove the plunger and load the first rod into the trocar using a gloved hand or forceps. Session V A, Slide #8

Two-Rod Implant Insertion: Step 6 • Gently advance the rod with the plunger toward the tip of the trocar until you feel resistance. • Never force the plunger. Session V A, Slide #9

Two-Rod Implant Insertion: Step 7 • Holding the plunger stationary with one hand, withdraw the trocar to the mark that is closest to the trocar tip. • Keep the obturator stationary and do not push the rod into the tissue • Withdraw trocar and plunger together until mark (2) closest nearest to trocar tip (do not remove trocar from skin till both rods are inserted). Session V A, Slide #10

Two-Rod Implant Insertion: Step 8 • The rod should have been released under the skin when the mark closest to the tip of the trocar is visible at the insertion point. • Release of the rod can be checked by palpation. Session V A, Slide #11

Two-Rod Implant Insertion: Step 9 • To place the second rod , align the trocar so that the second rod will be positioned at about a 30 -degree angle relative to the first. • Fix the position of the previous rod with the forefinger and middle finger of the free hand, and advance the trocar along the tips of the fingers. • This will ensure a suitable distance of about 30 degrees between the rods and keep the trocar from puncturing the previously inserted implant. Session V A, Slide #12

Two-Rod Implant Insertion: Step 10 • Leave a distance of about 5 mm between the incision (puncture) and the tips of the rods. • This will minimize the risk of spontaneous expulsions. Session V A, Slide #13

Two-Rod Implant Insertion: Step 11 • After placement of the second rod, use a sterile gauze to apply pressure briefly to the insertion site and ensure there is no bleeding. • Palpate the other ends of the rods to make sure that both have been properly placed. • Ask the woman to palpate the implants to confirm their presence Session V A, Slide #14

Two-Rod Implant Insertion: Step 12 Press the edges of the incision together, and close the incision with a skin closure. Apply a sterile gauze and wrap the arm with a pressure bandage. Session V A, Slide #15

Post Insertion steps • Before removing gloves, Ø Dispose the used needle (without capping) and the single use trocar in a sharp’s container, Ø Wipe the non-disposable instruments with a wet cloth or soak in water at point of use to remove any tissue or blood before further cleaning and processing. Ø Dispose the waste materials like cotton, gauze in leakproof container or plastic bag Ø Decontaminate surfaces that may have been contaminated by blood, such as the procedure table or instrument stand, by wiping them down with 0. 5% chlorine solution. • Remove gloves by turning them inside out and place them in a leakproof container or plastic bag. Session V A, Slide #16 • Wash hands thoroughly and dry.

Post-Insertion Instructions • Instruct woman about wound care and inform her that she can make a return visit appointment, if necessary • Discuss what to do if she experiences any problems or sideeffects following insertion. She can return at anytime if she has any questions or concerns. • Assure her that she can have the implant removed at any time if she desires. • Ask her to repeat the instructions and answer her questions. • Observe the client for at least 15– 20 minutes before sending her home • If possible, give her a client card with details of date of insertion, type and batch number of implant, arm of insertion and date of removal. Session V A, Slide #17

Client Instructions for Wound Care at Home after Insertion • The client should keep the area around the wound dry and clean for 48 hours. • She can take off the pressure bandage after 2 days and the band aid/ surgical tape after 5 days. • Slight bruising, swelling at the insertion site is normal and will subside in a few days. • She can start doing routine work immediately. She should avoid lifting heavy weight, bumping or applying unusual pressure at the incision site. • After healing, the area can be washed and touched as usual. Session V A, Slide #18