Nexplanon Insertion Procedure Note

PRE-OP DIAGNOSIS: desired long-term, reversible contraception
 POST-OP DIAGNOSIS: Same
 PROCEDURE: Nexplanon ® placement
 Performing Physician: _
 Supervising Physician (if applicable): _
 
 PROCEDURE:
 ICON : _ Negative
 Site (check): [_] Right Arm [_] Left Arm Serial # _
 Sterile Preparation: [_] Betadine [_] Chloraprep Expiration Date [_]
 
 Insertion site was selected 8 – 10 cm from medial epicondyle and marked along with guiding site using sterile marker
 Procedure area was prepped and draped in a sterile fashion. _ mL of 1% lidocaine _ with OR without epinephrine used for subcutaneous anesthesia. Anesthesia confirmed.
 Nexplanon ® trocar was inserted subcutaneously and then Nexplanon ® capsule delivered subcutaneously
 Trocar was removed from the insertion site.
 Nexplanon ® capsule was palpated by provider and patient to assure satisfactory placement.
 Estimated blood loss of _ mL
 Dressings applied: _ Adhesive Dressing _ Gauze/Tape _ Biocclusive
 Followup: The patient tolerated the procedure well without complications. Standard post-procedure care is explained and return precautions are given.