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: Pregnancy test: negative; reasonably certain not pregnant per US SPR criteria.

No contraindications identified.. Site (check): [_] Right Arm [_] Left Arm

Informed consent obtained, including risks of pain, paresthesia, bleeding, hematoma, scarring, infection, deep insertion with neurovascular injury, and migration including to pulmonary vessels.

Patient positioned supine with chosen arm flexed at elbow, externally rotated, hand under head. Insertion site was selected 8-10 cm from medial epicondyle and 3-5 cm posterior to the bicipital sulcus and marked along with guiding site using sterile marker Procedure area was prepped and draped in a sterile fashion. Sterile Preparation with chlorhexadine. _ mL of 1% lidocaine used for subcutaneous anesthesia. Anesthesia confirmed. Nexplanon ® preloaded disposable applicator with a retractable needle was inserted subcutaneously and then Nexplanon ® rod delivered subcutaneously. Applicator was removed from the insertion site. Full 4-cm Nexplanon ® rod was palpated by clinician and patient to assure satisfactory placement. Estimated blood loss of <1 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:  fever, spreading erythema or purulent drainage, expanding hematoma, persistent paresthesia or numbness, inability to palpate the implant, and lower abdominal pain. If not inserted during days 1-5 of cycle or if switching methods, 7 days of a backup method will be required.