Removal of NEXPLANON

Before initiating the removal procedure, the health care provider should carefully read the instructions for removal and consult the USER CARD and/or the PATIENT CHART LABEL for the location of the implant. The exact location of the implant in the arm should be verified by palpation. If the implant is not palpable, two-dimensional x-ray can be performed to verify its presence.

A non-palpable implant should always be first located prior to removal. Suitable methods for localization include: two-dimensional x-ray, x-ray computerized tomography (CT), ultrasound scanning (USS) with a high-frequency linear array transducer (10 MHz or greater), or magnetic resonance imaging (MRI). If these imaging methods fail to locate the implant, etonogestrel blood level determination can be used for verification of the presence of the implant. For details on etonogestrel blood level determination, call 1-877-467-5266 for further instructions.

After localization of a non-palpable implant, consider conducting removal with ultrasound guidance.

There have been occasional reports of migration of the implant; usually this involves minor movement relative to the original position. This may complicate localization of the implant by palpation, CT, USS and/or MRI, and removal may require a larger incision and more time.

Exploratory surgery without knowledge of the exact location of the implant is strongly discouraged. Removal of deeply inserted implants should be conducted with caution in order to prevent injury to deeper neural or vascular structures in the arm and be performed by health care providers familiar with the anatomy of the arm.

Removal procedure

Step 1.

Clean the site where the incision will be made and apply an antiseptic. Locate the implant by palpation and mark the distal end (end closest to the elbow), for example, with a sterile marker (Figure 1).

Step 2.

Anesthetize the arm, for example, with 0.5 to 1 mL 1% lidocaine at the marked site where the incision will be made (Figure 2). Be sure to inject the local anesthetic under the implant to keep it close to the skin surface.

Step 3.

Push down the proximal end of the implant (Figure 3) to stabilize it; a bulge may appear indicating the distal end of the implant. Starting at the distal tip of the implant, make a longitudinal incision of 2 mm towards the elbow.

Step 4.

Gently push the implant towards the incision until the tip is visible. Grasp the implant with forceps (preferably curved mosquito forceps) and gently remove the implant (Figure 4).

Step 5.

If the implant is encapsulated, make an incision into the tissue sheath and then remove the implant with the forceps (Figures 5 and 6).

Step 6.

If the tip of the implant does not become visible in the incision, gently insert a forceps into the incision (Figure 7). Flip the forceps over into your other hand (Figure 8).

Step 7.

With a second pair of forceps carefully dissect the tissue around the implant and grasp the implant (Figure 9). The implant can then be removed.

Step 8.

Confirm that the entire implant, which is 4 cm long, has been removed by measuring its length. If a partial implant (less than 4 cm) is removed, the remaining piece should be removed by following the removal instructions above. If the woman would like to continue using NEXPLANON, a new implant may be inserted immediately after the old implant is removed using the same incision.

Step 9.

After removing the implant, close the incision with a steri-strip and apply an adhesive bandage.

Step 10.

Apply a pressure bandage with sterile gauze to minimize bruising. The woman may remove the pressure bandage in 24 hours and the small bandage in 3 to 5 days.