# Nexplanon Removal

## Overview

This module describes how to remove a Nexplanon contraceptive implant.

## Indications

## Contraindications

## Patient information and consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“You are ready for the removal of your Nexplanon implant. This is a short and simple procedure with minimal discomfort.”

### What can my patient expect?

“I will give you an injection for pain first. I will make a small cut where the implant is, and then I’ll pull it out with tweezers.”

### What is my patient’s role?

“Keep still with your hand behind your head while I remove the implant. Fearing blood or needles is normal, but tell me if you have fainted from it. Let me know if you have any pain.”

## Preparation

Prepare a trolley with equipment.

### Documentation

### Equipment

## Site & Positioning

Position the patient with their arm (containing the implant) flexed, and the hand behind their head. Palpate the arm to locate the extraction site, usually 8-10 cm proximal to the medial epicondyle and 3-5 cm inferior, overlying the triceps. On depressing the proximal end of the implant, the distal end should pop up under the skin.

## Procedure

Follow medical asepsis with sterile gloves.

## Troubleshooting

I can’t palpate the implant OR I can’t remove it.

Stop and refer the patient to a provider experienced in difficult removals.

After removal, I want to insert a second Nexplanon.

You can do this through the same incision.

I suspect I didn’t get the entire implant out.

These implants can sometimes break, resulting in incomplete removal. Refer the patient to a provider experienced in difficult removals.

## Risks

## References