Selected Safety Information
- If follicular development occurs, atresia of the follicle is sometimes delayed, and the follicle may continue to grow beyond the size it would attain in a normal cycle. Generally, these enlarged follicles disappear spontaneously. Rarely, surgery may be required.
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.
Prior to removal
The woman does not have allergies to the antiseptic or anesthetic to be used
The following equipment is needed for the removal of the implant:
An examination table for the woman to lie on
Sterile surgical drapes, sterile gloves, antiseptic solution, sterile marker (optional)
Local anesthetic, needles, and syringe
Sterile scalpel, forceps (straight and curved mosquito)
Skin closure, sterile gauze, adhesive bandage and pressure bandages
Replacing NEXPLANON (etonogestrel implant)
The new implant may be inserted in the same arm, and through the same incision from which the previous implant was removed. If the same incision is being used to insert a new implant, anesthetize the insertion site [for example, 2 mL of lidocaine (1%)] applying it just under the skin along the 'insertion canal.'
Follow the subsequent steps in the insertion procedure.