How to Insert Nexplanon

David Fuller

Last Updated On: September 19, 2025

Choosing a birth control method is a personal decision, and for many women, convenience and long-term reliability are key factors. Around the world, millions rely on modern contraceptives to manage family planning and reproductive health, with growing numbers turning to long-acting reversible contraceptives (LARCs) for their ease and effectiveness.

Nexplanon, a small implant placed just under the skin of the upper arm, is one of the most trusted LARC options. With a single procedure, it provides up to three years of pregnancy protection, freeing women from the daily or monthly routines required by other methods.

Still, many patients wonder what the actual insertion process is like. How is the implant placed? What should they expect during and after the procedure? In this article, we’ll walk through how Nexplanon is inserted, what happens step by step, and how both patients and healthcare professionals can prepare for a smooth experience.

Key Takeaways

• Thorough preparation, including a comprehensive medical history, informed consent, and clear counseling, helps ensure a safe and smooth insertion of Nexplanon.
• The implant should be placed subdermally in the non-dominant arm, using proper technique to avoid deep placement and confirm palpation afterward.
• Sterility, correct angling, and patient education are central to minimizing complications and building patient trust.
• After insertion, patients can return to normal activities but should keep the pressure bandage on for 24 hours and avoid bumping the arm until tenderness subsides.
• Tracking the three-year replacement date is the most reliable way to maintain protection, as changes in bleeding or other symptoms are not necessarily signs of reduced effectiveness.

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Preparing the Patient for Nexplanon Insertion

Good preparation is a cornerstone of a safe and successful Nexplanon insertion. Taking time to review medical details, explain the procedure, and ensure patient comfort helps reduce risks while building trust. A careful approach allows patients to feel supported and confident about their decision.

Preparation Steps

• Medical History Review: Assess for contraindications, including active breast cancer, unexplained vaginal bleeding, sensitivity to implant components, active liver disease or tumors, and current or past thrombosis or thromboembolic disorders. A complete review helps confirm if Nexplanon is appropriate.
  
• Timing Considerations: Insertion during the first five days of the menstrual cycle provides immediate protection. If placed at another point in the cycle, backup contraception is advised for seven days. A pregnancy test may be performed if timing or history is unclear.
  
• Informed Consent: Providers should review benefits, risks, and alternatives while explaining the procedure and what to expect afterward. This empowers patients to make informed decisions.
  
• Positioning: The implant is placed in the non-dominant arm, bent at the elbow, with the hand resting under the head. The insertion point is about 3–5 cm posterior to the biceps–triceps sulcus. This position ensures good visibility and accuracy.
  
• Patient Counseling: Discuss potential side effects, including irregular bleeding patterns. Reassure patients that bleeding changes are common and not a sign of reduced effectiveness.

Thorough preparation improves safety, reduces anxiety, and lays the groundwork for a smoother experience during the procedure.

Step-by-Step Technique for Inserting Nexplanon

Correct technique ensures both patient safety and reliable contraceptive protection. The preloaded applicator is designed to make insertion straightforward, but precision is key to success.

Insertion Technique

1. Mark the insertion site: Measure 8–10 cm above the medial epicondyle of the non-dominant arm and mark 3–5 cm posterior to the biceps–triceps sulcus. Accurate marking helps avoid deeper structures like nerves and vessels.
   
2. Prepare the skin: Clean thoroughly with antiseptic and use a local anesthetic to keep the patient comfortable.
   
3. Position the applicator: Hold at a 30° angle with the bevel up, inserting just under the skin. View from the side and lift the skin slightly to avoid going too deep.
   
4. Advance and deploy: Lower the applicator until parallel to the skin, advance fully, then release the implant by pressing the slider.
   
5. Verify placement: Confirm the implant is not retained in the applicator. Palpate the site to feel the rod and document placement.

Following this structured method reduces the risk of incorrect placement, migration, or removal difficulties, and reassures both provider and patient that the implant is positioned correctly.

Best Practices for Minimizing Complications During Insertion

While the Nexplanon implant is designed for safety, complications can occur if the insertion process is not done properly. Following best practices helps minimize risks and enhances patient confidence.

• Maintain sterility: Use sterile gloves and equipment to lower the chance of infection.
  
• Avoid deep placement: Keep the applicator parallel to the skin to ensure subdermal placement. Deep insertion increases the chance of nerve involvement or difficulty with removal.
  
• Palpate after insertion: Confirm the rod is easily felt under the skin before concluding the procedure.
  
• Educate on warning signs: Counsel patients about swelling, redness, pain, or difficulty locating the implant. Early recognition allows timely medical review.
  
• Self-checks, not routine follow-ups: Advise patients to regularly check that they can feel the implant. Routine scheduled visits are not required, but patients should return promptly if they cannot palpate it or notice concerning symptoms.

By applying these practices, providers lower risks, maintain patient safety, and strengthen trust throughout the contraceptive process.

Post-Insertion Care and Patient Counseling for Nexplanon

After insertion, proper care supports healing and patient reassurance. The arm is wrapped with a pressure bandage, which should be kept in place for 24 hours. Patients can resume normal daily activities right away, but they should avoid bumping or pressing the arm while it is still tender. Some mild swelling, bruising, or discomfort may occur, which can be eased with over-the-counter pain relief or a cold compress.

Patient counseling after insertion is vital for long-term satisfaction. Providers should:

• Remind patients that Nexplanon is effective for up to three years and must be replaced afterward.
  
• Emphasize that bleeding changes are common during use and do not indicate the implant is losing effectiveness. The expiration timeline, not bleeding patterns, is what determines reliability.
  
• Explain warning signs to monitor, including infection at the site, persistent pain, or inability to feel the implant.
  
• Review the importance of tracking the replacement date. Discussing signs that Nexplanon is wearing off in the context of approaching expiration helps patients plan ahead and avoid gaps in coverage.

Clear, practical guidance helps patients feel confident, reassured, and in control of their reproductive health.

Conclusion

Mastering the Nexplanon insertion process involves more than placing the implant—it requires careful preparation, precise technique, and clear communication. When providers combine clinical skill with patient education, they not only improve safety but also foster confidence and long-term satisfaction.

By addressing both the technical and personal aspects of care, healthcare professionals can make the experience smooth, supportive, and effective for their patients.

FAQs

1. How long does the Nexplanon insertion procedure take?

The actual insertion takes only a few minutes, though the full visit may be longer to allow for preparation and counseling.

2. Does insertion of Nexplanon hurt?

Local anesthesia is used, so most patients feel only pressure or a quick pinch. Discomfort afterward is usually mild and temporary.

3. Can patients resume normal activities immediately after insertion?

Yes. Light activities are fine right away. Keep the pressure bandage on for 24 hours and avoid bumping or pressing the arm while it heals.

4. What if the implant cannot be felt after insertion?

Return to your provider immediately. Imaging (ultrasound or X-ray) may be used to confirm placement. Use backup contraception until the implant’s location is confirmed.

References

370 million women globally using contraceptives, report shows. Family Planning 2030. Published April 24, 2025. https://www.fp2030.org/global_search_item/370-million-women-globally-using-contraceptives-report-shows/

Palomba S, Falbo A, Di Cello A, Materazzo C, Zullo F. Nexplanon: the new implant for long-term contraception. A comprehensive descriptive review. Gynecological Endocrinology. 2012;28(9):710-721. doi:10.3109/09513590.2011.652247

Reed S, Minh TD, Lange JA, Koro C, Fox M, Heinemann K. Real world data on Nexplanon® procedure-related events: final results from the Nexplanon Observational Risk Assessment study (NORA). Contraception. 2019;100(1):31-36. doi:10.1016/j.contraception.2019.03.052