A dressing is then applied for 24 hours. The contraceptive effect wears off very quickly when the Implanon is removed, with most women returning to a normal menstrual cycle within a month. Implanon Removal. Refer to Box 1 for management of troublesome bleeding with the implant. Traditionally, and according to the product information, the implant is inserted on days 1—5 of the cycle day 1 being the first day of menstrual bleeding when pregnancy is excluded, and is effective immediately.
However, this can limit timely access, resulting in the chance of unintended pregnancy while waiting to have the implant inserted. When an implant is inserted using quick start, it will not be effective for the first seven days. An early pre-existing pregnancy may not be confidently excluded by a negative pregnancy test if intercourse occurred without reliable contraception in the previous three weeks. Limited evidence from studies and extensive post-marketing surveillance does not indicate an increased risk of teratogenesis if a pregnancy is inadvertently exposed to etonogestrel.
Informed consent and clear instructions are required to:. The main risk is an undiagnosed pregnancy because of amenorrhoea or spotting being falsely attributed to the effects of the implant. Family planning organisations in Australia have extensive experience with quick start, demonstrating the feasibility and benefits of the method Box 2. A consent form for implant procedures may be useful www.
A consent form for quick start is also available www. The following information is not comprehensive, but highlights important and commonly encountered aspects of the procedures.
Ensure that there is adequate time, a good light source and complete set of equipment. Some women will feel anxious about the procedure, and may benefit from reassurance and distraction. Position the woman lying on the examination bed with her arm flexed and externally rotated, and her hand next to her head. Ideally, the clinician is seated to facilitate visualisation of the needle during insertion. It can be efficient to infiltrate with local anaesthetic before setting up the rest of the equipment, re-washing hands and donning sterile gloves.
To minimise pain, a local anaesthetic can be administered, using a small gauge long needle eg 25G 1. The local anaesthetic should be at room temperature when administered. Allow at least a few minutes for the local anaesthetic to work and check for absence of a sharp sensation prior to insertion.
Reassure the woman that she is likely to continue to feel pressure sensation after local anaesthetic. If there is insufficient numbness to sharp sensation after 2 minutes, it is worth waiting another 1—2 minutes before considering if further local anaesthetic is needed. Use extreme caution to avoid intravascular injection for women with Wolff—Parkinson—White and Stokes—Adams syndromes. Non-compliance with instructions can lead to deep and impalpable implants. Deep insertion risks neurological and vascular damage, implant migration and, rarely, intravascular insertion.
Significant implant site reactions are uncommon, although bruising can be expected. Use hand hygiene, sterile gloves and correct skin disinfection to avoid infection. The implant should be removed or replaced at three years.
If replacement occurs at or prior to the expiry date, there is no need for additional contraceptive precautions. If the implant has expired, a history is taken to ascertain the risk of pregnancy since the expiry date.
If a woman wishes to have a new implant inserted, this can be initiated using quick start. If an implant that is due for removal is difficult to palpate, clinicians who are not experienced in deep removals should refer the patient to a specialised service. Potential removal-related risks include neurovascular damage. An unsuccessful attempt to remove an implant may make subsequent removals more complex procedures because of swelling and scarring.
If an implant is impalpable, removal should not be attempted; carry out a pregnancy test and discuss the need for additional contraception until the implant is located by ultrasonography or X-ray.
Bent implants are likely to continue to be effective. Broken implants are uncommon, and should be referred to an experienced practitioner for removal. If an implant is being replaced, perform a removal and insert the new implant into the incision created for removal.
After insertion and re-insertion, provide the woman with the card that comes in the pack and clear post-insertion instructions, including when the method will become effective. Advise the date for removal for the woman to record. Consider the use of a practice software reminder at three years. For all implant procedures, give advice to keep the site dry and clean for three to five days and to expect some bruising. Some redness, swelling and local pain may occur but are usually minor.
Procedural Medicare Benefits Schedule MBS item numbers for Implanon NXT are hormone or living tissue implantation by cannula and etonogestrel subcutaneous implant, removal of, as an independent procedure. An attendance item may be applicable for consultation that is independent of the procedure s. Placement of the implant at alternative sites should be undertaken with caution. If a contraceptive implant was inserted in another country, check carefully for the number of rods.
A two-rod, five-year implant called Jadelle is available in New Zealand. Contraception: An Australian clinical practice handbook. They not been personally financially remunerated for these services. MSD is the sponsor of the contraceptive implant in Australia.
Australian Family Physician. Search for: Search AFP. Filter Relevance Date. Issues by year. Volume 46, Issue 3, March Implanon NXT: Expert tips for best-practice insertion and removal. It is a highly effective, long-acting reversible contraceptive method, which is suitable for most women across the reproductive lifespan.
Objective This article provides practical advice for clinicians who already insert and remove the contraceptive implant, as well as advice for those who have not yet acquired this procedural skill. She stays fully awake throughout the procedure. The health care provider makes a small incision in the skin near the site of insertion. With the fingers, the provider pushes the implant toward the incision and then uses forceps to pull out the implant. A woman may feel tugging, slight pain, or soreness during the procedure and for a few days after.
The provider closes the incision with an adhesive bandage. Stitches are not needed. An elastic bandage may be placed over the adhesive bandage to apply gentle pressure for 2 or 3 days and keep down swelling.
0コメント