Contraceptive rods Session IV B OneRod rod Removal

Contraceptive rods Session IV B: One-Rod rod Removal Session IV B, Slide #1

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

Implanon/Implanon NXT Removal: Step 1 • Have the client lie on her back with her arm ( washed and dried) flexed at the elbow and place a clean cloth under her arm. If removing an Implanon NXT rod which was inserted into the new location above the triceps, place the client’s hand behind her head. • Locate the rod by palpation and mark the distal end (end closest to the elbow). • Clean area thoroughly with an antiseptic. Session IV B, Slide #3

Implanon/Implanon NXT 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 rod. Session IV B, Slide #4

Implanon/Implanon NXT Removal: Step 3 • Push down the proximal tip of the rod; a bulge may appear indicating the distal end of the rod. • Starting at the distal tip of the rod, make a longitudinal (along the rod) incision of 2 mm towards the elbow Session IV B, Slide #5

Implanon/Implanon NXT Removal: Step 4 A B C • Gently push the rod toward the incision until the tip is visible. • Grasp the rod with mosquito forceps and remove it (see image A and B) • If the rod is encapsulated, make an incision into the tissue sheath and then remove the rod with the forceps (see image C) Session IV B, Slide #6

Implanon/Implanon NXT Removal: Step 5 A B C • If the tip of the rod is still not visible, gently insert a forceps into the incision and grasp the rod (see image A). • Flip the forceps over with your other hand gently pull out the distal part of the rod (see image B). • If needed, carefully dissect fibrotic tissue around the rod and grasp the rod with a second pair of forceps (see image C). With a second forceps, carefully dissect the tissue around the rod. • Ensure that the removed rod is intact and complete and show it to the client Session IV B, Slide #7

Implanon/Implanon NXT Removal: Step 6 • Close the incision with a skin closure. • Apply a sterile gauze and wrap the arm with a pressure bandage. Session IV B, Slide #8

Post Removal steps • Before removing gloves: Ø Dispose the removed rod as per local guidelines 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 syringe and needle in a sharps container Ø Dispose of contaminated items like gauze, cotton, etc. in a leak-proof container or plastic bag Ø Decontaminates 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 placing them in a leakproof container or plastic bag. • Wash hands thoroughly and dry. • Complete client record. Session IV B, Slide #9

Post removal instructions • Instruct the client about wound care and inform her that she can make a return visit appointment, if needed. • Discuss what to do if any problems occur and answer any questions. • Counsel client on other contraception options if she desires and help her get it. • Observe the client for at least 15– 20 minutes before sending her home. Session IV B, Slide #10

Client Instructions for Wound Care at Home after Removal • 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 IV B, Slide #11

Post-removal Options • If client wants a new Implanon NXT -The new guidance recommends that it should be inserted in the same arm and using the same incision from which the previous rod was removed, as long as the site is in the new location, toward the back of the arm, over the triceps muscle. • In cases where the previous insertion was in the old insertion site over the groove between the biceps and triceps muscles (i. e. the sulcus), the provider will need to shift to the new insertion site. Inform the client of site. • If the woman decided to discontinue using the rod and does not want to become pregnant, counsel her about other contraceptive options and help her get it if desired. Session IV B, Slide #12