Nexplanon Insertion

HISTORY:

Presents for Nexplanon ‍insertionchange

Current contraception: ‍none ‍ for the last ‍ years

Reason for ‍choosingchanging Nexplanon: ‍ ‍



Last menstrual period: ‍ ‍daysweeksmonths ago

Menstrual cycles: ‍ days, ‍regularirregular

Menstrual symptoms: ‍nonepainheavy bleeding

G‍01234 P‍01234 A‍01234

Desire for pregnancy in the next year: ‍yesno



Sexual activity: ‍activeinactive, ‍ partners, ‍menwomenmen and women

Condom use: ‍alwayssometimesno

History of STIs: ‍none ‍

Last Pap smear: ‍ ‍monthsyears ago ‍never

HPV vaccination: ‍up-to-dateincompleteunvaccinated



Contra-indications: ‍none of the followings

‍pregnancy

‍breast cancer

‍active liver disease

‍history of DVT or PE

‍unexplained vaginal bleeding



EXAM:

General appearance: ‍well-appearing

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness



ASSESSMENT:

Contraceptive implant insertion, ‍well-tolerated



PLAN:

- Pregnancy test prior to insertion

- STI screening prior to insertion

Nexplanon Insertion:

- Consent: informed of potential risks including infection, expulsion, or perforation, benefits of long-term contraception discussed, consent obtained

- Preparation: skin cleaned with ‍betadinechlorhexidine

- Anesthesia: ‍nonelocal with ‍cc of ‍lidocaine ‍2 without epi

- Procedure: Nexplanon inserted in the inner, upper, ‍rightleft arm, bandage applied

- Tolerance: ‍well toleratedarm pain

- Instructions: keep bandage dry and in place for 24 hours, avoid heavy lifting with the arm for a few days, use backup contraception for the first week

- Advise to check the implant by touch regularly

- Counseling on condom use for STI prevention

- Referral to gynecologist

- Follow-up if ‍ ‍monthsyears or if complications/concerns arise

- Return if side effects occur, such as persistent pain, redness, swelling, or if the implant can no longer be felt