Implanon Insertion Course

Lesson 1 • Medical Eligibility Criteria Frameworks

Applies WHO and CDC medical eligibility criteria categories 1–4 to Implanon. Provides a structured decision-making tool for complex patient histories.

Lesson 2 • Pre-Insertion Pregnancy Exclusion

Establishes protocols for ruling out pregnancy before insertion using clinical and laboratory methods. Prevents inadvertent insertion in pregnant patients.

Lesson 3 • Drug Interactions and Efficacy Impact

Reviews CYP3A4 inducers, anticonvulsants, and antiretrovirals that reduce etonogestrel efficacy. Guides clinicians to adjust contraceptive plans accordingly.

Lesson 4 • Absolute and Relative Contraindications

Distinguishes absolute contraindications from relative ones requiring individualised assessment. Ensures clinicians recognise high-risk presentations before insertion.

Lesson 1 • Deep or Migrated Implant Complications

Explains causes of deep or migrated implants, clinical signs, imaging‑guided retrieval options, and referral pathways for specialist removal of complex cases.

Lesson 2 • Immediate Insertion Complications

Covers recognition and management of vasovagal syncope, insertion‑site haematoma, and failed rod deployment, giving clinicians rapid response strategies to maintain patient safety.

Lesson 3 • Infection and Wound Complications

Identifies signs of insertion-site infection and distinguishes from normal healing. Guides antibiotic selection and removal decision-making.

Lesson 4 • Non-Palpable Implant Management

Outlines the stepwise approach when the rod cannot be palpated post-insertion. Prevents unnecessary re-insertion before localisation is confirmed.

Lesson 1 • Post-Insertion Self-Monitoring Instructions

Instruct patients to palpate the rod, distinguish normal from abnormal sensations, and watch for warning signs like migration, infection, or pain, enabling effective self‑monitoring and prompt reporting to their provider.

Lesson 2 • Side Effects and Bleeding Patterns

Prepares patients for irregular bleeding, amenorrhoea, and hormonal side effects. Reduces early discontinuation by setting accurate expectations.

Lesson 3 • Procedure Explanation and Anxiety Reduction

Walks patients through insertion steps using plain language and visual aids. Reduces procedural anxiety and improves cooperation during insertion.

Lesson 4 • Benefits and Effectiveness Counselling

Communicates efficacy rates, convenience advantages, and non-contraceptive benefits clearly. Builds patient confidence and realistic expectations.

Lesson 1 • Post-Insertion Palpation and Confirmation

Describes immediate bimanual palpation to verify rod location, assess length and depth, document placement, and apply a pressure dressing, ensuring clinical confirmation and patient comfort post‑procedure.

Lesson 2 • Applicator Insertion Mechanics

Demonstrates needle insertion at a 20‑degree angle with skin‑tenting using the non‑dominant hand, bevel‑up orientation, and controlled advance to the hub, placing the rod in the subdermal plane for efficacy.

Lesson 3 • Local Anaesthesia Administration

Administers lidocaine along the insertion track using correct volume and technique. Minimises patient discomfort without distorting subcutaneous tissue.

Lesson 4 • Rod Deployment and Applicator Withdrawal

Outlines the coordinated retract‑and‑hold technique that deploys the rod smoothly, confirms full release before withdrawing the applicator, and checks for displacement to ensure proper placement and avoid re‑insertion.

Lesson 1 • Post-Removal Wound Care

Applies closure strips, pressure dressing, and aftercare instructions after removal. Ensures optimal healing and patient understanding of wound care.

Lesson 2 • Pre-Removal Assessment and Planning

Requires confirming rod location via thorough palpation and, if needed, ultrasound or X‑ray before incision, providing a systematic pre‑removal evaluation that reduces complications and improves success.

Lesson 3 • Standard Removal Technique

Demonstrates the push technique with a 2mm incision over the rod tip. Achieves clean extraction with minimal scarring in straightforward cases.

Lesson 4 • Difficult Removal Techniques

Covers the U-technique and modified techniques for encapsulated or deep rods. Prepares clinicians for challenging extractions without specialist referral.

Lesson 1 • Efficacy Duration and Replacement

Analyses hormone depletion curves and evidence for 3-year versus extended use. Prepares clinicians to counsel on optimal replacement timing.

Lesson 2 • Device Structure and Components

Examines the rod's ethylene vinyl acetate core, barium sulphate coating, and applicator design. Connects physical structure to insertion technique requirements.

Lesson 3 • Contraceptive Mechanisms

Covers ovulation suppression, cervical mucus thickening, and endometrial changes. Links each mechanism to overall efficacy and failure rate data.

Lesson 1 • Procedural Documentation Standards

Specifies mandatory components for recording insertion/removal: device lot, expiration, site, arm, palpation confirmation, deviations/complications, and provider signatures, ensuring comprehensive medicolegal documentation.

Lesson 2 • Patient Follow-Up Protocols

Schedules post‑procedure follow‑up at one month and annually, detailing assessments—palpation check, side‑effect review, and contraceptive counselling—to identify issues early and reinforce adherence.

Lesson 3 • Competency Assessment and Credentialing

Defines supervised insertion minimums, competency checklists, and credentialing renewal. Ensures ongoing clinical proficiency across the provider team.

Lesson 4 • Quality Improvement in Implant Services

Applies audit cycles, complication tracking, and patient satisfaction data to improve services. Drives continuous improvement in implant programme outcomes.

Lesson 1 • Identifying the Medial Bicipital Groove

Demonstrates palpation and visual techniques to locate the sulcus between biceps and triceps. Ensures consistent placement in the correct subcutaneous plane.

Lesson 2 • Dominant vs. Non-Dominant Arm Selection

Explains clinical rationale for preferring the non-dominant arm and exceptions. Guides individualised site selection based on patient factors.

Lesson 3 • Upper Arm Anatomy Review

Maps major muscles, peripheral nerves, and arterial/venous structures of the non‑dominant upper arm—biceps, triceps, median and ulnar nerves, and brachial artery—to guide safe insertion site selection.