Subcutaneous Testosterone Pellet Insertion

Testpak^® kit:

Half shallow tray (1)

Non-latex sterile gloves (1)

Fenestrated drape with adhesive (1)

Gauze, 4 × 4 (5), 2 × 2 (2)

Alcohol wipes (3)

PVP swabsticks (1)

10 mL BD syringe (1)

Needle 18G × 1½ in. (1)

Needle 27G × 1½ in. (1)

#11 blade scalpel (1)

30 mL medicine cup (1)

Adson forceps (1)

Steri-Strips ¼ × 3 (1)

Skin marker (1)

Tegaderm™ bandage (1)

Benzoin swabstick (1)

Trocar kit :
Sharp-ended stylet (1)
Blunt stylet (1)
Trocar (1)

Suturing supplies (optional):
5-0 dissolvable gut suture
Crile hemostatic forceps
Mayo scissors, straight

Fig. 10.1

Picture of packs

Utilizing sterile technique, open Testopak^® on a metal tray so that the white paper wrapping becomes a sterile field (Fig. 10.2). Before donning sterile gloves, empty trocar and introducer kit onto field. Proceed to empty optional sutures, sterile scissors, and hemostatic forceps. Don sterile gloves and arrange contents starting at left corner and moving counterclockwise: PVP iodine swabsticks pre-opened, large bore needle connected to 10 mL syringe, marker, #11 scalpel , blue shallow tray with medication cup and Adson forceps, trocar and introducer, drape, stacked 4 × 4 gauze, 2 × 2 gauze, alcohol prep pads, transparent occlusive dressing and Steri-Strips with benzoin swabsticks, or optional hemostatic forceps, scissors, and sutures. Use a sterile 4 × 4 gauze to grasp non-sterile vial of 2 % lidocaine with epinephrine and proceed to fill 10 mL syringe with large bore needle. Disconnect large bore needle and connect 27 gauge 1.5” needle. Do not discard large bore needle in case the patient may require an additional dose of local anesthetic . Note that the vial of 2 % lidocaine with epinephrine is not placed onto the sterile field. Lastly, open individual Testopel^® ampules, one at a time, and drop into medication cup that is in the blue shallow tray (Fig. 10.3). Be cautious that the pellet is vertical and loose while inside the ampule prior to opening, because the ampule is narrow and a horizontal-lying pellet easily adheres to the walls of the ampule.

Fig. 10.2

Picture of necessary equipment arranged on tray

Fig. 10.3

Testopel^® testosterone pellets

Procedure

Position the patient in a lateral decubitus position, Fig. 10.4. Cleanse the site with povidone iodine, painting a large area on the upper outer quadrant of the hip. Place the fenestrated drape over the site. Mark two sites on the skin (think of a “V” formation with half of the pellets along each arm of the “V”) for ten pellets or three sites for 12 (think of a “W” formation with a third of the pellets along each arm of the “W”) (Fig. 10.5). Next, inject 2 % lidocaine with epinephrine to begin hydrodissection along the tracks in the subcutaneous fat, and anesthetize the entire length of the tracts for the trocar. For this, we like to use a spinal needle to ensure coverage of the distal end of the tracks. Leave a weal of lidocaine solution at the insertion site for the skin incision which will follow (Fig. 10.6).