All healthcare providers performing insertions and removals of IMPLANON must receive instruction and training, and where appropriate, supervision prior to inserting or removing IMPLANON.
Information concerning the insertion and removal of IMPLANON will be sent upon request free of charge. Contact Merck at 1-877-IMPLANON (1.877.467.5266).
Before initiating the removal procedure, the healthcare provider may consult the USER CARD that is kept by the patient and/or the Patient Chart Label. The arm in which IMPLANON is located should be indicated on the USER CARD and the Patient Chart Label. IMPLANON should have been inserted in the medial aspect of the upper non-dominant arm.
Prior to removing IMPLANON, carefully read the instructions for removal.
Find IMPLANON by palpation. If IMPLANON cannot be palpated, use either ultrasound with a high-frequency linear array transducer (10 MHz or greater) or magnetic resonance imaging to localize the implant. Consider conducting difficult removals with ultrasound guidance. Only remove a non-palpable implant once the location of IMPLANON has been established. If these imaging methods fail, call 1-877-IMPLANON (1.877.467.5266) for further instructions.
There have been occasional reports of migration of the implant; usually this involves minor movement relative to the original position. This may complicate localization of the implant by palpation, ultrasound or magnetic resonance imaging, and removal may require a larger incision and more time.
Exploratory surgery without knowledge of the exact location of the implant is strongly discouraged. Removal of deeply inserted implants should be conducted with caution in order to prevent damage to deeper neural or vascular structures in the arm and be performed by healthcare providers familiar with the anatomy of the arm.
The patient's position for removal is similar to the position for insertion. Use aseptic technique.
The following equipment is needed for removal:
1. IMPLANON must only be removed by a healthcare provider who has been instructed and trained in the IMPLANON removal technique.
2. The arm in which IMPLANON is located should be indicated on the USER CARD and the Patient Chart Label. IMPLANON should be in the medial aspect of the upper non-dominant arm.
3. After confirming that the patient does not have any allergies to the antiseptic, wash the patient's arm and apply an antiseptic. Locate IMPLANON by palpation and mark the end closest to the elbow, for example, with a sterile marker.
4. After determining the absence of allergies to the anesthetic agent or related drugs, anesthetize the arm, for example, with 0.5 to 1 cc 1% lidocaine at the site where the incision will be made (near the tip of IMPLANON that is closest to the elbow). Be sure to inject the local anesthetic under IMPLANON to keep the implant close to the skin surface.
5. Make a 2–3 mm incision in the longitudinal direction of the arm at the tip of the implant closest to the elbow.
6. Gently push IMPLANON toward the incision until the tip is visible. Grasp the implant with forceps (preferably curved mosquito forceps) and pull it out gently.
7. If IMPLANON is encapsulated, make an incision into the tissue sheath and then remove IMPLANON with the forceps.
8. If the tip of the implant is still not visible after gently pushing it towards the incision (as in step 6), gently insert a forceps into the incision and grasp the implant. Turn the forceps around.
9. With a second forceps, carefully dissect the tissue around IMPLANON and then remove IMPLANON. Be sure to remove the IMPLANON rod entirely. Confirm that the entire rod, which is 40 mm long, has been removed by measuring its length.
If the patient would like to continue using IMPLANON, insert a new IMPLANON rod immediately after the old IMPLANON rod is removed. The new IMPLANON can be inserted in the same arm, and through the same incision, or a new IMPLANON can be inserted in the other arm.
If the patient does not wish to continue using IMPLANON and does not want to become pregnant, recommend another contraceptive method.
10. After removing IMPLANON, close the incision with a butterfly closure and apply an adhesive bandage.