1. Session V B, Slide #1 Contraceptive Implants Session V B: Two-Rod Implant Removal

2. Session V B, Slide #2 Two-Rod Implant Removal: Required Equipment An examination table Sterile surgical drapes and gloves Antiseptic solution Local anesthetic, needles, and syringe Sterile #11 scalpel, forceps (straight and curved mosquito) Skin closure, sterile gauze and compresses

3. Session V B, Slide #3 Two-Rod Implant Removal Step 1 Have the client lie on her back with her arm flexed at the elbow. Palpate the area to locate both implants. Clean the patient’s upper arm with an antiseptic solution and frame the area with a drape that has an opening.

4. Session V B, Slide #4 Apply a small amount of local anesthetic, such as lidocaine (1%) to the skin and under the ends of the implants (below the bottom of the “V”). This will raise the ends of the implants. Two-Rod Implant Removal Step 2

5. Session V B, Slide #5 Make a 4 mm incision with the scalpel close to the ends of the implants (below the bottom of the “V”). Do not make a large incision. Two-Rod Implant Removal Step 3

6. Session V B, Slide #6 Push each implant gently toward the incision with your fingers. When the tip is visible or near to the incision, grasp it with mosquito forceps. Two-Rod Implant Removal Step 4

7. Session V B, Slide #7 Use the scalpel, the other forceps, or gauze to very gently open the tissue sheath that has formed around the implant. Two-Rod Implant Removal Step 5

8. Session V B, Slide #8 Grasp the end of the implant with the second forceps and gently remove it. Repeat the procedure for the second implant. Two-Rod Implant Removal Step 6

9. Session V B, Slide #9 Close the incision with a skin closure. 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. Review post-removal instructions and other key messages. Clean or dispose of the instruments properly. Two-Rod Implant Removal Step 7

10. Session V B, Slide #10 Post-removal Options If the woman decided to keep using this method and is still eligible, insert a new set of implants through the same incision, or if the client prefers, use the other arm. If the woman decided to discontinue using implants and does not want to become pregnant, counsel her about other contraceptive options.