Implanon nxt implant 68mg

Contraception.

Before the introduction of the drug Implanon NKSTЃ, pregnancy must be excluded. The gynecologist is strongly recommended to take part in the training session in order to become familiar with the use of the Implanon NKSTЃ applicator and the methods of insertion and removal of the Implanon NKSTЃ implant. Before inserting the implant, you must carefully read the instructions for use and follow the instructions for inserting and removing the implant presented in the subsections How to insert Implanon NKSTЃ and How to remove Implanon NKSTЃ.

How to use Implanon NKSTЃ

Implanon NKSTЃ is a long-acting hormonal contraceptive. S / c one implant is inserted, which can remain at the insertion site for 3 years. The implant is removed no later than 3 years from the date of insertion. The woman should be informed about the possibility of removing the implant at any time, if she wishes. A gynecologist may consider removing the implant earlier in overweight women. After removal of the implant, immediate insertion of another implant will result in continued contraceptive protection. If a woman does not want to continue using Implanon NKSTЃ but needs contraception, another method of contraception should be recommended.

The basis for the successful application and subsequent removal of the Implanon NKSTЃ implant is the correct and accurate SC insertion of the implant in accordance with these instructions. Violation of the time and technique of implant insertion (see subsections When to insert Implanon NKSTЃ, How to insert Implanon NKSTЃ) can lead to pregnancy.

The Implanon NKSTЃ implant should be inserted sc, directly under the skin on the inner side of the shoulder to avoid injury to large blood vessels and nerves that are located deeper in the connective tissue between the biceps and triceps muscles.

Immediately after insertion of the implant, it is necessary to palpate its presence under the skin. If the implant cannot be found or its presence is in doubt, other diagnostic methods must be used to confirm its presence (see subsection How to insert Implanon NKSTЃ). Until the presence of an implant is confirmed, the woman should be advised to use a non-hormonal (barrier) method of contraception.

The packaging of Implanon NKSTЃ contains a User Card for recording the batch number of the implant. The gynecologist must record the date of insertion, indicate the arm into which the implant was inserted, and the planned day of its removal in the User Card. The packaging of the drug contains stickers for the records of the gynecologist, which indicate the batch number of the implant.

When to inject Implanon NKSTЃ

Important. Pregnancy must be ruled out before the implant is inserted.

The timing of administration depends on the woman's recent use of hormonal contraceptives as follows.

In the absence of the use of contraceptive hormonal drugs in the previous month. The implant should be inserted between the 1st day (1st day of menstrual bleeding) and the 5th day of the menstrual cycle, even if the menstrual bleeding is still ongoing.

If the implant is inserted correctly, an additional method of contraception is not required. If you deviate from the recommended period of implant insertion, the woman should be warned about the need to use a barrier method of contraception within the next 7 days. If during this period there was sexual intercourse, pregnancy should be excluded.

Switching from a hormonal method of contraception to Implanon NKSTЃ

When switching from a combined method of hormonal contraception (combined oral contraceptive (COC), combined hormonal vaginal ring, or combined hormonal transdermal patch). The implant should preferably be inserted on the day following the day of taking the last active tablet (the last tablet containing active ingredients) of the COC, but no later than the day following the usual interval in pill intake or the period during which the placebo COC tablets were taken. If a vaginal ring or transdermal patch was previously used, the implant should be inserted preferably on the day of removal, but no later than the day of the next application of the previous drug.

If the implant is inserted correctly, an additional method of contraception is not required. If you deviate from the recommended period of implant insertion, the woman should be warned about the need to use a barrier method of contraception within 7 days. If during this period there was sexual intercourse, pregnancy should be excluded.

When switching from a progestogenic method of contraception (for example, progestogen-only pills, injections, an implant, or hormonal intrauterine system (IUD). Since there are several types of progestogenic methods, the implant should be inserted as follows:

- injectable hormonal contraceptives: the implant is injected on the day when the next injection is needed;

- progestogen-only pills: a woman can switch from progestogen-only pills to Implanon NXTЃ any day. The implant must be inserted within 24 hours after taking the last tablet;

- implant / IUD: the implant is inserted on the day of the removal of the previous implant or IUD.

If the implant is inserted correctly, an additional method of contraception is not required. If you deviate from the recommended period of implant insertion, the woman should be warned about the need to use a barrier method of contraception within 7 days. If during this period there was sexual intercourse, pregnancy should be excluded.

After an abortion or miscarriage

- I trimester: the implant must be inserted within 5 days after an abortion or miscarriage in the I trimester;

- II trimester: the implant must be inserted between the 21st and 28th days after an abortion or miscarriage in the 2nd trimester.

If the implant is inserted correctly, an additional method of contraception is not required. If you deviate from the recommended period of implant insertion, the woman should be warned about the need to use a barrier method of contraception within 7 days. If during this period there was sexual intercourse, pregnancy should be excluded.

After childbirth

- For breastfeeding: the implant should be inserted at the end of the 4th week after childbirth (see 'Use in pregnancy and breastfeeding'). A woman should use a barrier method of contraception for 7 days after the implant is inserted. If during this period there was sexual intercourse, pregnancy should be excluded.

- If not breastfeeding: The implant should be inserted between 21 and 28 days after delivery. If the implant is inserted correctly, an additional method of contraception is not required. If you deviate from the recommended period of implant insertion, the woman should be warned about the need to use a barrier method of contraception within 7 days. If during this period there was sexual intercourse, pregnancy should be excluded.

How to administer Implanon NKSTЃ

The basis for the successful application and subsequent removal of Implanon NKSTЃ is the correct and accurate SC insertion of the implant into the non-dominant arm, in accordance with the instructions. The gynecologist and the woman should determine the presence of an implant by palpation after its insertion. The implant should be inserted directly under the skin. Too deep or incorrect insertion of the implant can be complicated by paresthesia (due to nerve damage), migration of the implant (due to intramuscular or fascial insertion) and, in rare cases, intravascular injection. In addition, when the implant is inserted too deeply, it may not be palpable and localization and / or removal may be difficult.

The introduction of the drug Implanon NKSTЃ should be performed under aseptic conditions and only by a qualified gynecologist who is well familiar with the administration method. The implant should only be inserted using a special applicator.

It is recommended that the gynecologist is seated throughout the insertion procedure so that he can clearly see the insertion site and the movement of the needle under the skin.

The woman should lie on the examination table on her back, bending her non-dominant arm at the elbow and turning it outward so that her wrist is parallel to her ear or her arm is next to her head (Figure 1).

Determine the insertion site, which is located on the inner side of the shoulder of the non-dominant arm approximately 8Ц10 cm above the medial epicondyle of the humerus. The implant should be inserted directly under the skin to avoid damage to large vessels and nerves, which are located deeper in the subcutaneous tissue in the intermuscular groove between the biceps and triceps muscles.

Make 2 marks with a sterile marker: firstly, mark the point at which the implant will be inserted, and secondly, mark a point located a few centimeters proximal to the first mark (Figure 2). The second mark will subsequently serve as a guide during insertion.

Treat the injection site with an antiseptic solution. The injection site is anesthetized (for example, using an anesthetic aerosol or injection of 2 ml of 1% lidocaine directly under the skin along the planned injection channel).

The sterile disposable Implanon NKSTЃ applicator containing the implant is removed from the blister. The applicator should not be used if there is any doubt about sterility.

The applicator is gripped directly over the needle in the textured area and the transparent protective cap is removed from the needle containing the implant (Figure 3). If the cap cannot be easily removed, this applicator should not be used. You can see the white-stained implant by looking at the tip of the needle. Do not touch the purple slider until the needle is fully inserted s / c, as this will retract the needle and prematurely release the implant from the applicator.

Using your free hand, stretch the skin around the insertion site with your thumb and forefinger (Figure 4).

The tip of a needle, located approximately at an angle of 30 ?, is used to pierce the skin. (Figure 5).

The applicator is lowered to a horizontal position. Lifting the skin with the tip of the needle, smoothly insert the needle along its entire length (Figure 6). You may feel a little resistance, but you should not apply too much pressure. If the needle is not inserted to its full length, the implant will not be inserted properly. The movement of the needle is more convenient to observe when the doctor is sitting and observing from the side, rather than looking from above. In this position, the insertion site and the movement of the needle are clearly visible.

The applicator is held in the same position after the full length of the needle has been inserted. If necessary, you can hold the applicator in the same position with your free hand during subsequent steps. Unlock the purple slider by gently pushing down on it. Move the slider all the way back until it stops (Figure 7). The implant is now under the skin and the needle is locked in the applicator. The applicator can then be removed. If the applicator is not held in a fixed position during the procedure, or the magenta slider is not fully moved backward, the implant will not be inserted.

After insertion, it is necessary to check for the presence of the implant under the skin of the shoulder by palpation. When palpating both ends of the implant, ensure that there is a 4 cm nail (Figure 8).

If it is impossible to feel the implant or there is doubt about its presence:

- check the applicator. The needle should be fully retracted and only the purple tip of the obturator should be visible;

- to confirm the presence of an implant, you can use: two-dimensional X-ray, X-ray computed tomography (CT scan), ultrasound scanning (USS) with a high-frequency ultrasound transducer for linear scanning (10 MHz or more) or MRI. If the presence of an implant cannot be confirmed by these imaging methods, it is recommended to determine the concentration of etonogestrel in the woman's blood plasma. Until the presence of an implant is confirmed, a non-hormonal (barrier) contraceptive method should be used;

- apply a small adhesive tape sticker to the injection site. Asking the woman to palpate the implant;

- Apply a sterile gauze bandage to reduce bruising. The woman can remove the pressure bandage after 24 hours, and the small patch from the insertion site after 3-5 days;

- fill out the User Card and give it to the woman for storage. In addition, the stickers are filled in and attached to the woman's medical record;

- The applicator is intended for single use only and must be properly disposed of in accordance with existing regulations for the management of biohazardous waste.

How to remove Implanon NKSTЃ

Before starting the removal procedure, the gynecologist must establish the location of the implant indicated in the User Card and check it by palpation. If the implant is not palpable, then additional examination methods should be used to confirm its presence (see subsection If it is impossible to feel the implant or there is doubt about its presence).

After localization of the non-palpable implant, the possibility of surgical removal of the implant under USS control is considered.

There are rare reports of implant movement; usually it concerns a slight movement relative to the initial position, with the exception of too deep introduction (see also 'Special instructions'). This can complicate the localization of the implant by palpation, ultrasound and / or MRI, and removal may require a larger incision and more time.

Removal of the implant should only be performed under aseptic conditions by a gynecologist who is familiar with the removal technique.

Surgery to locate an implant without knowing its exact location is not recommended.

Removal of deeply inserted implants should be performed with care to avoid damage to the deep nerve or vascular structures of the shoulder, and should be performed by a specialist with a good knowledge of the anatomy of the shoulder.

The site of the future incision is treated with an antiseptic. Locate the implant by palpation and mark its distal end (the end closest to the elbow), for example with a sterile marker (Figure 9).

The site where the incision will be made is anesthetized, for example, 0.5Ц1 ml of 1% lidocaine solution (Figure 10). Make sure that the local anesthetic is injected under the implant so that it stays close to the skin surface.

Press on the proximal end of the implant (Figure 11) to secure it; a bulge may appear on the skin, which will indicate the distal end of the implant. Starting at the distal end of the implant, a 2 mm longitudinal incision is made towards the elbow.

Gently push the implant towards the incision until the tip appears. Grasp the implant with a surgical clamp (preferably a mosquito clamp) and remove the implant (Figure 12).

If the implant is enclosed in a connective tissue sheath, an incision is made in the tissue sheath and then the implant is removed with a surgical forceps (Figures 13 and 14).

If the tip of the implant is not visible after the incision, carefully insert the surgical forceps into the incision (Figure 15).

Grab the implant. The clamp is turned over and taken in the other hand (Figure 16).

With the second clamp, carefully separate the tissue around the implant and grab the implant (Figure 17). The implant can then be removed.

If a woman wants to continue using Implanon NKSTЃ, then a new implant can be inserted immediately, immediately after removing the old implant, into the same incision (see How to replace Implanon NKSTЃ).

After removal of the implant, close the incision with sterile strips of tissue (ster-strip) and apply a sticker from an adhesive plaster.

Apply a sterile pressure bandage to reduce bruising. The woman can remove the pressure bandage after 24 hours and the bandage after 3-5 days.

How to replace Implanon NKSTЃ

Immediate replacement can be done after removal of the previous implant and is similar to the insertion procedure described in How to Inject Implanon NKSTЃ. A new implant can be inserted at the same site and through the same incision from which the previous implant was removed. If the same incision is used to insert a new implant, the injection site is anesthetized (for example, 2 ml of 1% lidocaine solution), injected directly under the skin, starting with the removal incision, along the insertion channel, and the subsequent steps of the insertion instructions are followed. Additional information and more detailed instructions regarding the insertion and removal of the implant can be obtained from the manufacturer.

Progestogen-only hormonal contraceptives should not be used if any of the conditions / diseases listed below are present. If any of the listed conditions occur during the period of using the drug Implanon NKSTЃ, you should immediately stop using the drug.

hypersensitivity to the active substance or any excipient of Implanon NKSTЃ;

thrombosis (arterial and venous) and thromboembolism currently or in history (including thrombosis, deep vein thrombophlebitis, pulmonary embolism, myocardial infarction, ischemic or hemorrhagic cerebrovascular disorders);

the presence of antibodies to phospholipids;

migraine with focal neurological symptoms;

breast cancer, incl. history;

established or suspected malignant hormone-dependent tumors;

benign or malignant liver tumors currently or in history;

severe forms of liver disease (before normalization of liver function tests), incl. jaundice, congenital hyperbilirubinemia (including history);

uncontrolled arterial hypertension;

vaginal bleeding of unknown etiology;

pregnancy (including presumed);

childhood.

With caution (if any of the conditions or risk factors listed below are present, the benefits of using the implant should be weighed against the possible risks for each individual woman and discussed with her before she decides to start using Implanon NKSTЃ. intensification or at the first appearance of any of these conditions, a woman should consult a doctor, after which the doctor should decide whether to continue using or discontinue Implanon NKSTЃ): prolonged immobilization caused by surgery or other reasons; conditions preceding thrombosis (including transient ischemic attacks, angina pectoris, complicated lesions of the valvular apparatus of the heart, atrial fibrillation, extensive trauma); persistent arterial hypertension; diabetes mellitus, incl.diabetes mellitus with diabetic angiopathy; hereditary or acquired predisposition to arterial thrombosis, incl. deficiency of protein C, protein S, antithrombin III; liver disease of mild and moderate severity with normal liver function tests; anticoagulant therapy; severe depression.