Session V A, Slide #1

Contraceptive Implants

Session V A: Two-Rod Implant Insertion

Session V A, Slide #2

Two-Rod Implant Insertion: Required Equipment

• An examination table• Sterile surgical drapes and

gloves• Antiseptic solution• Local anesthetic, needles,

and syringe• #10 trocar, forceps,

#11 scalpel (optional) • Skin closure, sterile gauze,

and compresses

Session V A, Slide #3

Two-Rod Implant Insertion: Trocar

The trocar usually has three marks:

1) The mark closest to the hub indicates how far the trocar should be introduced under the skin to place the implants.

2) The middle mark (small arrow), if included on the trocar, should be ignored for two-rod implant insertions.

3) The mark closest to the tip indicates how much of the trocar should remain under the skin following placement of the first implant.

Session V A, Slide #4

Two-Rod Implant Insertion:

Step 1

• Have the client lie on her back with her nondominant arm flexed at the elbow and externally rotated.

• The implants will be inserted subdermally and positioned in a “V” shape.

Session V A, Slide #5

• Clean the client's upper arm with an antiseptic solution.

• Frame the insertion area with a drape that has an opening.

Two-Rod Implant Insertion:

Step 2

Session V A, Slide #6

Two-Rod Implant Insertion:

Step 3

• Open the package carefully by pulling apart the sheets of the pouch.

• Allow the two implants to fall onto a sterile drape.

Session V A, Slide #7

Two-Rod Implant Insertion:

Step 4

• Fill a 5-ml syringe with a local anesthetic, such as lidocaine (1%).

• Insert the needle under the skin and inject a small amount of anesthetic.

• Anesthetize two areas about 4.5 cm long, to mimic the V shape of the implantation site.

Session V A, Slide #8

Two-Rod Implant Insertion:

Step 5

• Use a scalpel to make a small skin incision (about 2 mm); many providers prefer to use the implant trocar to puncture the skin.

Session V A, Slide #9

Two-Rod Implant Insertion:

Step 6

• Insert the tip of the trocar beneath the skin at a shallow angle.

• Gently insert the trocar while lifting the skin; failure to do so may result in deep placement of the implants and could make removal more difficult.

• Advance the trocar to the mark nearest the hub of the trocar.

Session V A, Slide #10

Two-Rod Implant Insertion:

Step 7

• When the trocar has been inserted the appropriate distance, remove the obturator and load the first implant into the trocar using the thumb and forefinger.

Session V A, Slide #11

Two-Rod Implant Insertion:

Step 8

• Gently advance the implant with the obturator toward the tip of the trocar until you feel resistance.

• Never force the obturator.

Session V A, Slide #12

Two-Rod Implant Insertion:

Step 9

• Holding the obturator stationary, withdraw the trocar to the mark closest to the trocar tip.

• Keep the obturator stationary and do not push the implant into the tissue.

• Do not completely remove the trocar until both implants have been placed (withdraw only to the mark closest to its tip).

Session V A, Slide #13

Two-Rod Implant Insertion:

Step 10

• The implant should have been released under the skin when the mark closest to the tip of the trocar is visible at the insertion point.

• Release of the implant can be checked by palpation.

Session V A, Slide #14

Two-Rod Implant Insertion:

Step 11

• To place the second implant, align the trocar so that the second implant will be positioned at about a 30-degree angle relative to the first.

• Fix the position of the previous implant with the forefinger and middle finger of the free hand, and advance the trocar along the tips of the fingers.

• This will ensure a suitable distance of about 30 degrees between implants and keep the trocar from puncturing the previously inserted implant.

Session V A, Slide #15

Two-Rod Implant Insertion:

Step 12

• Leave a distance of about 5 mm between the incision (puncture) and the tips of the implants.

• This will avoid spontaneous expulsions.

Session V A, Slide #16

Two-Rod Implant Insertion:

Step 13

• After placement of the second implant, a sterile gauze may be used to apply pressure briefly to the insertion site and ensure there is no bleeding.

• Palpate the other ends of the implants to make sure that both have been properly placed.

Session V A, Slide #17

Two-Rod Implant Insertion:

Step 14

• Press the edges of the incision together, and close the incision with a skin closure.

Session V A, Slide #18

Two-Rod Implant Insertion:

Step 15

• 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.

• Fill out the user card and give it to the client.

• Review post-insertion instructions and other key messages.

• Clean or dispose of the instruments properly.