If you cannot palpate the implant or are in doubt of its presence, the implant may not have been inserted or it may have been inserted deeply:

  • Check the applicator. The needle should be fully retracted and only the purple tip of the obturator should be visible
  • Use other methods to confirm its presence
    • Given the radiopaque nature of the implant, suitable methods for localisation are two-dimensional X-ray and X-ray computerised tomography (CT scan). Ultrasound scanning (USS) with a high-frequency linear array transducer (10 MHz or greater) or magnetic resonance imaging (MRI) may be used
    • If the implant cannot be found in the arm after comprehensive localisation attempts, consider applying imaging techniques to the chest as extremely rare cases of migration to the pulmonary vasculature have been reported. If the implant is located in the chest, surgical or endovascular procedures may be needed for removal; healthcare professionals familiar with the anatomy of the chest should be consulted
    • If at any time these imaging methods fail to locate the implant, etonogestrel blood level determination can be used for verification of the presence of the implant. Please contact the local representative of the Marketing Authorisation Holder for further guidance*
  • Until you have verified the presence of the implant, the woman must use a non-hormonal contraceptive method
  • Deeply-placed implants should be localised and removed as soon as possible to avoid the potential for distant migration
  • A non-palpable implant should always be located prior to attempting removal

To view instructions on localisation and removal of a non-palpable implant, please see the ‘HOW TO REMOVE NEXPLANON®’ (etonogestrel 68 mg implant) section.

*You can contact the local representative of the Marketing Authorisation Holder, Organon, by: telephone – 02081 593593; email – medicalinformationuk@organon.com.

Prescribing information and adverse event reporting >

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Reference: 1. NEXPLANON® Summary of Product Characteristics