Peer Responses:
Length: A minimum of 275 words per post, not including references
Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
Clinical Experience: Nexplanon Placement
I am so excited to share my clinical experience since it has been a goal I have finally accomplished this term. In the family practice setting, my preceptor often counsels and provides all available contraceptive methods to her patients. The CDC offers an in-depth and detailed summary table titled “Table A1: Summary of Classifications for Hormonal Contraceptive Methods and Intrauterine Devices” that providers may use as a reference to determine the best contraceptive choice regarding individual considerations and conditions (Centers for Disease Control and Prevention [CDC], 2019). Nexplanon is a single-rod progestin contraceptive implant inserted subdermally in a women’s inner upper arm for long-acting reversible pregnancy prevention (Darney, 2022). According to data from a prospective study, the mean etonogestrel blood concentration is sufficient to provide contraception for at least five years. (Darney, 2022). Still, it is only approved for three years of use (Darney, 2022). Most women are eligible for Nexplanon implant contraception; however, there are a few medical conditions where the risk outweighs the benefit, such as existing breast cancer, thromboembolic disorders, undiagnosed bleeding, suspected pregnancy, and severe liver disease (Darney, 2022).
Women at high risk of unwanted pregnancy, such as adolescents and patients having induced abortion(s), are great candidates for Nexplanon implantation because they are more likely to discontinue other options (Darney, 2022). Progestin-only contraceptives have the advantage of containing no estrogen, are reversible, and are highly effective in preventing pregnancy (Darney, 2022). Another advantage is that Nexplanon only must be replaced every three years (Darney, 2022). Unplanned or breakthrough bleeding, prevalent with implants, is one of the class’s disadvantages (Darney, 2022). Additional disadvantages are that placement is invasive and does not protect against STIs (Darney, 2022).
When inserting a Nexplanon, the provider measures 3 to 5 cm (1.25 to 2 inches) posterior to the sulcus between the biceps and triceps muscles and 8 to 10 cm (3 to 4 inches) from the medial epicondyle of the humerus (Darney, 2022). To raise a wheal along the planned path of the rod insertion needle, 1 to 2 mL of 1 percent lidocaine is injected into the dermis (Darney, 2022). With a 2 to 5 mL syringe and a needle of 25 gauge and 1.5 inches long, the local anesthetic is administered just beneath the skin (Darney, 2022). Then, while holding the applicator at a 30-degree angle to the skin, the clinician inserts the needle against the insertion site (Darney, 2022). The provider punctures the skin around the insertion site while giving counter-traction to the area (Darney, 2022). When the needle is in the subdermal connective tissue, the provider lowers the applicator until it is parallel to the skin and lifts it with the needle tip without forcing it into the skin above (Darney, 2022). The entire needle length must be advanced (Darney, 2022). The implant won’t be properly implanted if the needle is not thoroughly inserted under the skin (Darney, 2022). Next, the slider is freed by applying downward finger pressure to the lever (Darney, 2022). The provider then fully retracts the slider and removes the applicator (Darney, 2022). The skin is palpated immediately after insertion to confirm proper rod placement; both ends should be detectable (Darney, 2022). An adhesive closure, such as a sterile strip, is then applied to the insertion puncture after the patient has had a chance to feel the implant, and the area is then wrapped with a pressure bandage (Darney, 2022).
My preceptor has allowed me to observe and assist with several Nexplanon and IUD placements but never had I had the opportunity to place a Nexplanon implant or insert an IUD independently. She has even allowed me to remove Nexplanon implants independently under supervision. A patient had a follow-up visit after contraceptive counseling for a Nexplanon placement, and as usual, I went in to assist my preceptor. Surprisingly and without warning, she instructed me to prep the patient and administer lidocaine. After that, she instructed me to place the Nexplanon! I was ecstatic and very proud of myself. The patient was amazing, and I talked her through the procedure, and unbeknownst to her, I was talking myself through it too. My preceptor told me I did very well, and my patient said she felt nothing, which certainly boosted my confidence. My next goal is to place an IUD independently if given the opportunity.
References
Centers for Disease Control and Prevention. (2019, October 6). US selected practice recommendations for contraceptive use, 2016. Retrieved March 20, 2023, from https://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/combined.html
Darney, P. D. (2022). Etonogestrel contraceptive implant (C. A. Schreiber & K. Eckler, Eds.). UpToDate. Retrieved March 20, 2023, from https://www.uptodate.com/contents/etonogestrel-contraceptive-implant?search=contraceptive%20implants%26source=search_result&selectedTitle=1~87&usage_type=default&display_rank=1
Peer Responses: Length: A minimum of 275 words per post, not including reference
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