PRE-OP DIAGNOSIS: desired long-term, reversible contraception POST-OP DIAGNOSIS: Same PROCEDURE: Nexplanon ® placement Performing Physician: _ Supervising Physician (if applicable): _ PROCEDURE: ICON : _ Negative Site (check): [_] Right Arm [_] Left Arm Serial # _ Sterile Preparation: [_] Betadine [_] Chloraprep Expiration Date [_] Insertion site was selected 8 – 10 cm from medial epicondyle and marked along with guiding site using sterile marker Procedure area was prepped and draped in a sterile fashion. _ mL of 1% lidocaine _ with OR without epinephrine used for subcutaneous anesthesia. Anesthesia confirmed. Nexplanon ® trocar was inserted subcutaneously and then Nexplanon ® capsule delivered subcutaneously Trocar was removed from the insertion site. Nexplanon ® capsule was palpated by provider and patient to assure satisfactory placement. Estimated blood loss of _ mL Dressings applied: _ Adhesive Dressing _ Gauze/Tape _ Biocclusive Followup: The patient tolerated the procedure well without complications. Standard post-procedure care is explained and return precautions are given.
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