There have been occasional reports of migration of the implant; usually this involves minor movement relative to the original position, but may lead to the implant not being palpable at the location in which it was placed. An implant that has been deeply inserted or has migrated may not be palpable and therefore imaging procedures, as described below, may be required for localisation.

A non-palpable implant should always be located prior to attempting removal.

• Given the radiopaque nature of the implant, suitable methods for localisation include two-dimensional X-ray and X-ray computer tomography (CT). Ultrasound scanning (USS) with a high-frequency linear array transducer (10 MHz or greater) or magnetic resonance imaging (MRI) may be used
• Once the implant has been localised in the arm, the implant should be removed by an HCP experienced in removing deeply placed implants and familiar with the anatomy of the arm. The use of ultrasound guidance during the removal should be considered

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; HCPs 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
• If the implant migrates within the arm, removal may require a minor surgical procedure with a larger incision or a surgical procedure in an operating room
• Removal of deeply inserted implants should be conducted with caution in order to help prevent damage to deeper neural or vascular structures in the arm

Non-palpable and deeply inserted implants should be removed by HCPs familiar with the anatomy of the arm and removal of deeply-inserted implants.

Exploratory surgery without knowledge of the exact location of the implant is strongly discouraged.

Please contact the local representative of the Marketing Authorisation Holder for further guidance.*

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

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Reference: 1. NEXPLANON^® (etonogestrel 68 mg implant) Summary of Product Characteristics