Transcript: What I need you to know about Nexplanon Counseling | New Nurse Practitioners

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Transcript

Liz Rohr: 

Well, hey there. It's Liz Rohr from Real World NP and you're watching NP Practice Made Simple, the weekly videos to help save you time, frustration, and help you learn faster so you can take the best care of your patients.

I have very few pet peeves. I'm pretty chill. I don't even feel like this is a pet peeve necessarily, but if I had to consider it, it has to be around Nexplanon knowledge and counseling. Because really what happens is that ... I do Nexplanon insertions and removals. I love women's health. Reproductive justice is really important to me, and I definitely find that some providers feel very squeamish about it. I don't know if it's from lack of knowledge or just disinterest. But basically what happens is that either, one, I will have a patient who comes to the visit for their Nexplanon insertion, and hasn't really been counseled at all, so they don't really know what they're getting themselves into.

I have 30 minutes for that procedural visit, but that takes an entire half an hour typically. I'm pretty fast now, but it still takes a lot of time. So what happens is that I'll do the counseling and the procedure in the same visit. Then I tend to run behind. I don't even care about that quite honestly. The pet peeve is really more the second scenario that I see. We have patients who are coming to me for a Nexplanon removal that I didn't place, that I didn't know about the counseling. I wasn't involved in any of that. So they're coming to me being like, "I want to take this out. I just had it placed last week because of these side effects." Really that should never happen.

Let me backtrack. Usually that's totally fine. The way that I frame my Nexplanon counseling is that they have complete control over their bodies and they get to decide when it gets inserted, when it gets removed. That whole thing. But the scenario was more talking about like, "I had no idea this was going to happen." That's the thing that really frustrates me.

So, in this video I'm going to be talking about everything that I recommend, keeping it short and sweet so that you feel comfortable when patients come to you asking you about Nexplanon so that you can give them an overview. You don't have to be an expert. It's really pretty straightforward. I'll just tell you exactly what I tell my patients, and then you can hopefully bring that back to your practice. Whether or not you feel like you like gynecology or not, or if you feel comfortable or not, hopefully it'll make it really simple.

First I just want to talk about the procedure itself. It's a 30-minute procedure typically. It depends on your clinic and what your policies are. 30 to 45 minutes are scheduled for insertions and removals. There's an informed consent form that you go through the risks, benefits, alternatives, side effects. Hopefully, again, you've been pre-counseled though so that you know what you're getting into, and you're just reaffirming those. Patients will sign that.

You'll clean off the area. It's a sterile procedure, so cleaning it off with iodine. Giving an injection of lidocaine usually with or without epinephrin and stuff to the personal preference of the provider. That is actually the worst part because a lot of patients are asking like, "Oh, is it painful and uncomfortable?" It's basically feels like a stinging, like a bee sting. That's what I've been told. I haven't experienced it myself, but that's the worst part because everyone's numb after that.

Once the numbness takes over, the device is injected through a very large needle, so I usually ask patients if they want to watch or not. But it's just an applicator device two seconds. It's really easy to insert. Then I just wrap up the site of insertion with a band-aid and some of that pressure gauze. That keeps it wrapped up so that you can reduce the bruising afterwards. Then the patients are just advised to watch out for pain, infection, and bleeding. Those are the main risks of the procedure.

Then coming back, if they have anything like redness or discharge or fever or anything like that. Hopefully avoided because it's a sterile procedure.

Then the removals are the same thing. The removals are informed consent, anesthetic. Then the main difference is that there's a very small incision with a scalpel, about one to three millimeters. Again, everything is numb, so they really don't feel anything. Then same thing, we just wrap it up afterwards.

Then the main thing about insertions is that it takes about seven days until they are fully effective. They need some sort of backup method. One other thing to consider is that patients will frequently come to their visits, if they are a female patient, with a male partner, a cis-male partner, and they are not using other contraceptives. If it's been within 10 days that they've had unprotected intercourse, they could possibly be pregnant without having a positive pregnancy test, if you remember that one.

But I do recommend having those conversations with patients before they come in. I'm not necessarily fond of the they have to come in for it, they have to come in for the counseling visit. If they can't, and they come to the procedure and I do the counseling, that's fine. Because I really don't want to make a barrier to access to contraception. But just keeping that in mind, that those are the recommendations. If they bring it up in the appointment, or if you're offering contraceptive options for them, just mentioning that.

Then the only other thing is, the main other thing I guess I should say, is about side effects. This is the number one thing I want you to keep from this video, is that you don't have to be an expert. It can just be quick and easy.

This is the way that I tell my patients. Basically when it comes to the Nexplanon, it's good for three years. You can take it out any time, and is really, really effective against protecting you from pregnancy. But there are a couple of side effects. Most people are really thrilled. Most people love the Nexplanon in my anecdotal experience. However, there are some side effects to consider before deciding if this is right for you.

Number one is bleeding. Absolutely number one across the board, most common side effect. There's four different options. One, your periods stay the same. Two, you get no period at all. Three, you can get this irregular spotting. Meaning small amounts of bleeding here and there erratically, or maybe a full-fledged period just here and there, not really on a schedule. Then the worst case scenario, which is very rare, but I do have to tell you this could be an option, is that somebody gets their period and it never goes away. They literally have a period every single day until you remove the Nexplanon again.

I let patients know that most of the time when patients get the Nexplanon and they have some side effects, their body will get used to it. So I usually recommend giving it a trial, about one to three months to see how they feel. And, if they get that intense daily bleeding that doesn't go away, to please call me because there are things that we can do about it for them.

So, far in a way that is the most common side effect that I definitely hope that you can take away from this in your counseling.

Then, there are other less common side effects. One is headaches. If somebody has headaches already, there is a risk that it could get worse or they could get new headaches that they didn't have before. That's just up to their discretion if they're willing to risk that for the benefits of having a long-term reversible contraceptive, the lark factor, that they don't have to think about taking as a pill every day. There's the headaches.

And then the other one is mood, definitely. Patients who have depression, where it's not managed completely, or bipolar that's not managed completely, could definitely get worse. Or even if it's under control or well-managed, it can, again, get worse.

Then there's a couple of other questions. Acne and weight gain. Weight gain is not necessarily as much. As, for example, like the Depo-Provera injection. But there is about a 14% of weight gain risk. I don't necessarily have data on the amount of weight gain. Then acne is, again, about like 14%. If somebody had really bad acne, you might want to consider not. I offer that to them as a risk and they get to make that decision. So there is a chance that your acne could get worse, so you have to weigh it from there.

Those are not the only side effects, but those are the main ones, definitely. The bleeding is the most important one that I feel like it's just so super easy to get off the bat, and see if they're even willing to entertain any abnormalities in their menstrual cycle, because some people aren't. Some people aren't.

That's it. Hopefully this video is helpful, and if you've made it this far, all the way to the end, thank you so, so much. You're making my dreams come true, a provider at collaboration. If you like this video hit like and subscribe and share with your NP friends, so together we can reach as many nurse practitioners as possible to make their practices a little bit easier. If you haven't already, grab the Ultimate Resource Guide for the new NP, head over to realworldnp.com/guide. You'll get these videos sent straight to your inbox every week, with patient stories, more insights, bonus content that I really just don't share anywhere else. Thank you so much for watching. Hang in there, and I'll see you soon.