1. This document provides instructions for inserting and removing double-rod implants, including preparing the patient, marking the insertion location, administering local anesthesia, and correctly inserting each rod at a 15 degree angle. 2. Key steps include preparing sterile materials and instruments, making a small incision, inserting the trocar and inserter to guide placement of the first rod, then reinserting to guide placement of the second rod. 3. Post-insertion care involves stopping any bleeding, applying a bandage, cleaning instruments with chlorine solution, and instructing the patient to keep the area clean and dry for 48 hours.

1. Session V
Practicing Insertion
and Removal Double-
Rod Implant

2. IMPLANT INSERTION
Correct insertion
(rod is placed underneath the skin)
Correct insertion will make the removal
easier

3. PREPARATION
1. Greet patients respectfully
2. Check medical record and assess the indication for
implant insertion
3. Explain the procedures and ask if clients have some
questions
4. Ask clients if they have history of allergy to antiseptics
and local anaesthetics

4. 5. Ask client to wash her hand

5. 6. Help clients to lay on the bed

6. 7. Place clean cloth under client’s hand

7. 8. Define the location for implant insertion: inner part of
upper hand, about 8 cm superior from fossa cubiti

8. 9.Use template to mark the location of two rods (to form
150 angle)

11. 10. Prepare materials and instruments

12. 11. Open the Implant package and put it in sterile basin

13. PRE-INSERTION PROCEDURES
1. Wash hand with soap and use clean towel

14. 2. Put on sterile gloves

15. if the gloves are covered with powder, clean it by soaking in
sterile water or DTT

16. 10. Make sure sterile instruments and DTT are already
prepared

17. 4. Prepare area of insertion with antiseptic solution, swab
from central to peripheral about 8-12 cm range. Then, let
it dry

18. 5. Put on sterile linen or DTT around client’s hand
6. Explain to client that she will be injected with local
anaesthesia so that she may feel a little pain

19. 6. Inject 0,3 -0,5 cc of 1% local anaesthesia 1% (without
epinephrine) subcutaneously right at the incision area.

20. 8. Continue the subcutaneous injection for about 5 cm and
inject 1 cc of local anaesthesia while pulling out the
needle gently.

21. 9. Remove the needle and place it in safe place to avoid
accident

22. 10. Gently push injection area to spread the anaesthesia
well.

23. 11. Touch the injected area with scalpel to know if the
anaesthesia is already working. If client still complaints
pain, wait for about 2 minutes and reassess the
anaesthesia effect.

24. INSERTION
1. Make shallow incision about 2 mm wide with scalpel
(alternatively, we can also directly penetrate the trocar
to subdermal area without incision)

25. On the trocar there are three marks
1 : Mark for inserting
trocar to subdermis
for Sinoplant
2 : Mark for inserting trocar to
subdermis for Norplant
3 : Mark for trocar tip that remains in subdermis after first
rod insertion
INDOPLANT
SINOPLANT
NORPLANT

26. 2. Insert trocar and inserter through incised area in narrow
angle

27. 3. While lifting the inserted trocar, push the trocar until first
mark is at the incised area

29. 4. Pull out the inserter
5. Insert first rod to the trocar by hand

30. Or insert the rod to trocar with pinset, open the other hand
below to catch the rod if it falls.

31. 6. Re-insert the inserter and push in until you feel resistance

32. 7. Hold the inserter with one hand, while the other hand is
pulling out the trocar

33. 8. Pull out the trocar and inserter together until mark 3 is
visible
Don’t remove the trocar from
incision area

34. 9. Slide the trocar tip to another side to make sure that the
first rod is inserted correctly.

35. 10. Hold the already inserted first rod with your finger to
avoid damage due to trocar re-insertion for the second
rod.

36. 11. Re-insert the trocar to the marked site (about 15° from
first insertion) until mark 1 is located at incision site.

37. 12. Insert second rod as the steps for first rod insertion
13. Palpate the implant to make sure they are correctly
inserted.

38. 14. Palpate incision area to make sure two rods are placed
about 5 mm away from incision site

39. POST INSERTION PROCEDURES
1. Push area of incision to stop bleeding

40. 2. Approximate edge of incision with elastic bandage.

41. 3. Put sterile bandage on insertion area to avoid bleeding
and swelling.

42. 4. Soak trocar, inserter and needle in 0.5%-chlorin 3X
before removal.

43. 5. Before putting-off the gloves,
place all instruments and gloves in
0.5% chlorin solution to prevent
contamination
6. Carefully remove all materials as
medical waste.
7. Put off gloves carefully

44. Care for insertion area
● Keep it clean and dry for at least 48 hours
incision wound may get infected if it is wet
● bandage removal can be performed after 48 hours
Elastic bandage can be removed after 3 - 5 days
● discoloration and edema are possible to be found and
considered as normal findings during few days after
insertion.

45. ● client can do their daily activites as usual but needs to
avoid heavy lifting or bumps.
● insertion and incision area can be touched when incision
wound is fully healed.
● visit the doctor immediately when pus is found