Procedure Insertion of Testosterone Pellet Implant (Male)

INSERTION SITE (Landmarks)

• Upper gluteal area (posterior) in a line between iliac crest and gluteal crease (see below)

o Several tracts, fanned superior to inferior (or vise versa)

PROCEDURE

• For gluteal insertion: place the patient on their side, rolled slightly anterior.

• Prep the skin with the three betadine swabs in concentric circles

• Use 12 cc’s of local anesthesia to anesthetize the skin and 4 or 5 subcutaneous tracts (≈5 cm in length)

• o 4cc’s 1% lidocaine with epinephrine, 4 cc’s 1% plain lidocaine and 4 cc’s Sodium Bicarbonate (prevents stinging)
• Make sure you inject a visible skin wheal.

• Using a #11 blade, make a small 5 mm transverse skin incision approximately 5 mm in depth

• Guide the sterile cannula with the sharp trocar into the subcutaneous tissue about 5 mm in depth. The tract should be parallel to the skin.

1. o This is directed medial towards lateral

2. o It can also be done the opposite direction

• Remove the sharp trocar and insert 3 or 4, 100 mg TE pellets into the cannula using the sterile forceps

• o Cover the opening with a thumb, finger tip or trocar so the pellets do not fall out
• Using the sterile blunt trocar, advance the pellets beyond the tip of the cannula holding the cannula securely in place

• Without removing the cannula and trocar, angle the cannula/blunt trocar inferiorly approximately 5 mm

• Repeat the insertion of 3 or 4 TE pellets (as described above) into this new tract, advancing the pellets with the blunt trocar

• Remove the cannula/blunt trocar together

• Reinsert the sharp trocar into the cannula and re-direct the cannula/trocar into a ‘new’ tract slightly inferior to the previous tract

• Again, without removing the cannula/blunt trocar, angle inferiorly and insert and additional 3 or 4, 100 mg TE implants

• Repeat if necessary, depending on the dose/ number of TE pellets inserted

• When all implants are inserted, remove the trocar and cannula

• Hold pressure continuously on the incision

• Cross skin tapes (steri-strips) over the incision

• Apply a dressing and have the patient hold pressure for 10 minutes

• Next insert, alternate sides

o If the initial insert was done on the right gluteal area, the next insert (approximately 4 months later) will be done on the left side

SUPPLIES NEEDED

• Trocar kit (www.trocarkit.com ), local anesthesia, tape

• Sterile testosterone pellets

Landmarks for the area of insertion: Anterior iliac spine Upper gluteal crease

Keep the placement of the pellets inferior to the beltline

Prep in concentric circles with 3 betadine swabs

Apply the sterile drape

Using a total of, 12 cc’s of lidocaine and bicarbonate, anesthetize the area of the implantation tracts and skin

Make sure to inject a visible skin wheal prior to making an incision

Sterile technique is a must

Superior Inferior Rotate

After making a 5 mm transverse skin incision, insert the sharp trocar into the cannula

Starting superiorly on the gluteal area, insert the trocar/cannula into the subcutaneous tissue up to the ‘hub’ of the cannula (where it flairs)

Remove the sharp trocar and insert 3 or 4, 100 mg TE pellets into the cannula

Using the blunt trocar, advance the pellets into the subcutaneous tissue, beyond the tip of the cannula (about 5 mm deep, just under the skin)

Rotate the cannula-blunt trocar slightly inferiorly, establishing a new tract

Pull the blunt trocar back, insert additional pellets and again, advance them into the subcutaneous tissue beyond the tip of the cannula

Remove the cannula-trocar, reinsert the sharp trocar and reinsert inferiorly into a new tract

Insert the pellets as above

Repeat the procedure, rotating the cannula inferiorly until the total dose of testosterone pellets have been inserted

Remove the cannula, hold pressure, and apply steri-strips and a sterile dressing

www.trocarkit.com