Explaining the Insertion Procedure for Jadelle and Norplant

A woman who has chosen implants needs to know what will happen during insertion. The following description can help explain the procedure to her. Learning to insert and remove implants requires training and practice under direct supervision. Therefore, this description is a summary and not detailed instructions.

Inserting implants usually takes only a few minutes but can sometimes take longer, depending on the skill of the provider. Related complications are rare and also depend on the skill of the provider. (Implanon is inserted with a specially made applicator similar to asyringe. It does not require an incision.)

1. The provider uses proper infection-prevention procedures.

2. The woman receives an injection of local anesthetic under the skin of her arm to prevent pain while the implants are being inserted. This injection may sting. She stays fully awake throughout the procedure.

3. The provider makes a small incision in the skin on the inside of the upper arm.

4. The provider inserts the implants just under the skin. The woman may feel some pressure or tugging.

5. After all implants are inserted, the provider closes the incision with an adhesive bandage. Stitches are not needed. The incision is covered with a dry cloth and the arm is wrapped with gauze.

Removing implants

Important: providers must not refuse or delay when a woman asks to have her implants removed, whatever her reason, whether it is personal or medical. All staff must understand and agree that she must not be pressured or forced to continue using implants.

A woman needs to know what will happen during removal. The following description can help explain the procedure to her. The same removal procedure is used for all types of implants.

1. The provider uses proper infection-prevention procedures.

2. The woman receives an injection of local anesthetic under the skin of her arm to prevent pain during implant removal. This injection may sting. She stays fully awake throughout the procedure.

3. The health care provider makes a small incision in the skin on the inside of the upper arm, near the site of insertion.

4. The provider uses an instrument to pull out each implant. A woman may feel tugging, slight pain, or soreness during the procedure and for a few days after.

5. The provider closes the incision with an adhesive bandage. Stitches are not needed. An elastic bandage may be placed over the adhesive bandage to apply gentle pressure for 2 or 3 days and keep down swelling.

If a woman wants new implants, they are placed above or below the site of the previous implants or in the other arm.

Supporting the user

Giving Specific Instructions

Keep arm dry

She should keep the insertion area dry for 4 days. She can take off the elastic bandage or gauze after 2 days and the adhesive bandage after 5 days.

Expect soreness, bruising

After the anesthetic wears off, her arm may be sore for a few days. She also may have swelling and bruising at the insertion site. This is common and will go away without treatment.

Length of pregnancy protection

Discuss how to remember the date to return.

Give each woman the following information in writing on a reminder card, like the one shown below, if possible, and explain:

− The type of implant she has

− Date of insertion

− Month and year when implants will need to be removed or replaced

− Where to go if she has problems or questions with her implants 

Have implants removed before they start to lose effectiveness

Return or see another provider before the implants start losing effectiveness (for removal or, if she wishes, replacement). 

Also if:

She has pain, heat, pus, or redness at the insertion site that becomes worse or does not go away, or she sees a rod coming out.

She has gained a lot of weight. This may decrease the length of time her implants remain highly effective.

General health advice: anyone who suddenly feels that something is seriously wrong with her health should immediately seek medical care from a nurse or doctor. Her contraceptive method is most likely not the cause of the condition, but she should tell the nurse or doctor what method she is using.