MSD IMPLANON, Справочное руководство

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• If the tip of the implant is not visible, gently insert a forceps
into the incision and grasp the implant (Figures G and H).
With a second forceps, carefully dissect the tissue around the
implant. The implant can then be removed (Figure I).
• Close the incision with a butterfly closure.
• Apply sterile gauze with a pressure bandage to prevent
bruising.
• There have been occasional reports of displacement of the
implant; usually this involves minor movement relative to the
original position. This may complicate localization of the implant
by palpation, USS, and/or MRI, and removal may require a
larger incision and more time.
• If the woman would like to continue using IMPLANON, a new
implant may be inserted immediately after the old implant is
removed (see “How to replace IMPLANON”).
• If the woman does not wish to continue using IMPLANON
and does not want to become pregnant, another contraceptive
method should be recommended.
How to Replace IMPLANON
• Replacement of IMPLANON should only be performed
under aseptic conditions and only by a health care provider
who is familiar with the insertion and removal procedure.
• Immediate replacement can be done after removal of
the previous implant as described in “How to Remove
IMPLANON.”
• The procedure to replace IMPLANON is similar to the
insertion procedure described in the section “How to Insert
IMPLANON.” The new implant can be inserted in the same
arm and often through the same incision from which the
previous implant was removed. If the same incision is being used,
the following instructions must also be taken into account.
• The small incision of the removal procedure can be used
as the entrance for the needle of the new applicator.
• Anesthetize the insertion site with 2 mL lidocaine (1%)
applied just under the skin commencing at the removal incision
along the “insertion canal.”
• During replacement, inserting the needle to its full length is
crucial; failure to do so will result in a partly visible implant
in the removal incision in the skin.
• The precise location of the implant is indicated on the
User Card.
• Locate the implant by palpation and mark the distal end.
(Figure A).
• Wash the area and apply an antiseptic.
• Anesthetize the arm with 0.5-1 mL lidocaine (1%) at the site
of incision, which is just below the distal end of the implant.
Note: Apply the anesthetic under the implant. Application
above the implant makes the skin swell, which may cause
difficulties in locating the implant (Figure B).
• Push down the proximal tip to fix the implant; a bulge may
appear, indicating the distal end of the implant. Starting below
the distal tip to the implant, make a longitudinal incision of 2
mm toward the distal tip of the implant (Figure C).
• Gently push the implant towards the incision until the tip is
visible. Grasp the implant with forceps (preferably “mosquito”
forceps) and remove it (Figure D).
• If the tip of the implant is not visible, there might be formation of
fibrotic tissue around the implant. The fibrotic tissue can be split
by continuing to cut toward the distal tip until the tip is clearly
visible. Remove the implant with forceps (Figures E and F).
How to Remove IMPLANON
Figure A
Figure D
Figure E Figure F
Figure B
Figure C
Figure G Figure H
Figure I