Nexplanon insertion

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NEXPLANON

FROM PRODUCT LABELING & INFORMATIONAL MATERIALS

Nexplanon Insertion Procedure Note
INDICATION - Progesti n-Only Contraception for 3 yrs'
TIMING / INDICATION
R/O PREGNANCY
If inserted as directed, no backup necessary
If deviation from rec insertion, use a backup method x 7 days
If not using hormonal, insert b/w days 1-5 of menstrual cycle
If COCP, Last active tablet day / or removal of ring / patch
MiniPill/progestin only – insert any day
If IUD, insert any day
If aborted in 1st tri, insert 5 days after
If aborted in 2nd trimester, insert b/w 21-28 days
Post-partum breastfeeding, after 4th post-partum week
Obese (>130% IBW) may be less effective, HTNive must be well controlled.
CONFIRM BEFORE STARTING
Review PMH & Exam, including GYNE!
Woman not preg & no other contra-indications such as
Known Preg
Hx of DVT or Clotting Disorder (!!!)
Benign or Malignant Liver Tumors, Active Liver Disease
Undiagnosed Abnl Genital Bleeding
Breast CA History
Allergy to Component
Understands Risks/ Benefits
Received a copy of patient labeling
Consent
No Allergy
PLACEMENT
8-10cm above medial epicondyle of humerous
Just under skin
2mL Lidocaine
30* angle tip
Verify placement by palpation
REMOVAL
May remove w/ scalpel, 1% Lidocaine. Can replace with another one at that time in same spot.
Fertility Returns within 1 week
EXPECT
Abnl Bleeding from Lighter to Heavy, 1st 3 mos are predictive
More likely to be an Ectopic Preg
Remove in event of THROMBOSIS
Ovarian Cysts may be larger
2-4lb weight gain over 2 yrs
MONITOR
Yearly Visits
TSH may vary but will return to normal
Drug Interaction w/ CYP3A4
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