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Learning to insert and remove implants requires training and practice under direct supervision. Therefore, the following illustrations and description serve as a summary and not detailed instructions for providers. The instructions apply after providing anesthetic.
Implanon insertion:
Step 1.
Mark the insertion site (where implant will be inserted). Stretch the skin around the insertion site with thumb and index finger.
Step 2.
Insert only the tip of the cannula (needle), slightly angled (about 20°).
Step 3.
Lower the applicator to a horizontal position.
Step 4.
Lift the skin with the tip of the needle, but keep the needle in the subdermal connective tissue. Gently insert, while lifting the skin, the needle to its full length, and keep the applicator parallel to the surface of the skin.
Step 5.
Break the seal of the applicator.
Step 6.
Turn the obturator (the rounded end of the applicator) a quarter turn (90°).
Step 7.
Fix the obturator with one hand against the arm, and with the other hand slowly draw the cannula (needle) out of the arm.
Jadelle and Sino-Implant (II) insertion:
Step 1.
Make a small incision with a scalpel or trocar in the skin on the inside of the upper arm. Alternatively, use the trocar to puncture the skin. Insert the tip of the trocar beneath the skin at a shallow angle. Gently advance the trocar superficially under the skin (not shown).Note: The trocar has three marks on it. The mark closest to the hub indicates how far the trocar should be introduced under the skin to place the Jadelle implants. The middle mark is not used. The mark closest to the tip indicates how much of the trocar should remain under the skin following placement of the first implant.
Step 2. When the trocar has been inserted to the mark closest to the hub, remove the obturator and load the first implant into the trocar, using thumb and forefinger.
Step 3.
Using the obturator to push, gently advance the implant towards the tip of the trocar until you feel resistance. Never force the obturator.
Step 4.
Holding the obturator stationary, withdraw the trocar to the mark closest to the trocar tip. The implant should be released under the skin at this point. It is important to keep the obturator stationary and to avoid pushing the implant into the tissue. Do not completely remove the trocar until both implants have been placed.
Step 5. To place the second implant, align the trocar so that the second implant will be positioned at about a 30° angle relative to the first implant. Repeat steps 3-4. The rods are placed in the shape of a V opening toward the shoulder. Leave a distance of about 5 mm between the incision and the tips of the implants. Remove the trocar.
Implant removal:
Step 1.
Make an incision (4 mm for Jadelle and Sino-Implant (II) and 2 mm for Implanon) with the scalpel close to the proximal ends of the implants (below the bottom of the V for Jadelle and Sino-Implant (II), and below the single rod for Implanon). Do not make a large incision.
Step 2.
Push each implant gently towards the incision with the finger. When the tip of the rod is visible, grasp it with the forceps and gently pull out the rod with the forceps. Repeat procedure for the second implant (Jadelle and Sino-Implant (II)).
Sources: Organon 1999 (9), Organon 2005 (10), Population Council 2005 (11), Sivin 2002 (13), and World Health Organization 2007 (17)
