1. Session IV A, Slide #1 Contraceptive Implants Session IV A: One-Rod Implant Insertion

2. Session IV A, Slide #2 One-Rod Implant Insertion: Required Equipment An examination table Sterile surgical drapes (optional) and gloves Antiseptic solution Local anesthetic, needles, and syringe Implanon applicator Skin closure, sterile gauze, and compresses

3. Session IV A, Slide #3 Implanon Applicator

4. Session IV A, Slide #4 Implanon Insertion: Step 1 Have the client lie on her back with the arm that she doesn’t normally use flexed at the elbow and externally rotated. Implanon should be inserted sub-dermally just under the skin.

5. Session IV A, Slide #5 Implanon Insertion: Step 2 Remove the sterile disposable applicator carrying Implanon from the blister pack. While keeping the shield on the needle, visually verify the presence of the implant, seen as a white body inside the needle-tip.* Following visual confirmation, the implant should be lowered back into the needle. *If the implant is not seen, tap the top of the needle shield against a firm surface to bring the implant into the needle tip.

6. Session IV A, Slide #6 Implanon Insertion: Step 3 Mark the insertion site with a marker. Make 2 marks: –First, mark the spot where the rod will be inserted. –Second, mark a spot a few centimeters proximal to the first mark. This second mark will later serve as a direction guide during insertion.

7. Session IV A, Slide #7 Implanon Insertion: Step 4 Clean the client’s upper arm with antiseptic solution. Frame the insertion area with a drape that has an opening (optional). Anesthetize the insertion area with anesthetic spray or by injecting 2 cc of 1% lidocaine just under the skin along the planned insertion tunnel).

8. Session IV A, Slide #8 Implanon Insertion: Step 5 Remove the needle shield. Stretch the skin around the insertion site with thumb and index finger.

9. Session IV A, Slide #9 Implanon Insertion: Step 6 Insert the tip of the needle, at about a 20 degree angle.

10. Session IV A, Slide #10 Implanon Insertion: Step 7 Release the skin. Lower the applicator to a horizontal position.

11. Session IV A, Slide #11 Implanon Insertion: Step 8 Lift the skin with the tip of the needle, keeping the needle in the subdermal connective tissue. While lifting the skin, gently insert the entire needle. Keep the applicator parallel to the surface of the skin.

12. Session IV A, Slide #12 Implanon Insertion: Step 9 Break the seal of the applicator.

13. Session IV A, Slide #13 Implanon Insertion: Step 10 Turn the rounded end of the obturator a quarter turn, about 90 degrees.

14. Session IV A, Slide #14 Implanon Insertion: Step 11 Hold the obturator against the clients’ arm with one hand. With your other hand, slowly draw the needle out of the arm. Never push against the obturator.

15. Session IV A, Slide #15 Implanon Insertion: Step 12 Check the needle to make sure the implant is absent. After retraction of the cannula, the grooved tip of the obturator should be visible.

16. Session IV A, Slide #16 Implanon Insertion: Step 13 Verify the presence of the implant by palpating the site. Apply a sterile gauze and wrap the arm with a pressure bandage. Before the client is discharged, observe her for a few minutes for signs of bleeding from the insertion site. Fill out the user card and give it to the client. Review post-insertion instructions and other key messages. Dispose of the applicator and syringe properly.