Nexplanon Removal Consent Form

 
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Consent To Remove Nexplanon
  • Nexplanon is licensed to have a contraceptive effect for three years after insertion. After this time it needs to be removed and replaced or another form of contraception used.
  • After removal, the hormone levels from the implant become undetectable within a few days. This means that without another method of contraception the patient can potentially fall pregnant soon afterwards.
  • A small dose of local anaesthetic is injected into the skin at the lower end of the implant to numb the skin. When numb, a small cut is made through which the implant can be pushed to remove it.
  • Steristrips are placed over the site of the cut to hold the skin edges together to allow healing. The area will need to be kept clean and dry for 5 days.
  • A pressure bandage will be placed over the wound to reduce the risk of bruising or swelling. This can be removed after 24 hours.
  • There is a small chance of infection occurring at the wound. Please report redness/pus (rare)
I have read the above and consent to the removal of the Nexplanon device as described
Additional contraception has been advised for seven days after removal/replacement of Nexplanon:: *

Privacy Consent

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