MSD IMPLANON, Справочное руководство

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• Stretch the skin around the insertion site with thumb and
index finger (Figure 1).
• Insert first only the tip of the needle, slightly angled (~20°)
(Figure 2).
• Release the skin.
• Lower the applicator to a horizontal position (Figure 3).
• While lifting the skin, gently insert the needle to its full
length. Do not exert force. The needle should be inserted
parallel to the skin to ensure that IMPLANON is inserted
superficially just under the skin (Figure 4).
• Keep the applicator parallel to the surface of the skin.
• When the implant is placed too deeply,
paresthesia and migration of the implant may
occur. Moreover, removal can be difficult later.
• Break the seal of the applicator (Figure 5).
• Turn the obturator 90° (Figure 6).
• Fix the obturator with 1 hand parallel to the arm and with
the other hand slowly retract the cannula (needle) out of
the arm (Figure 7).
• Never push against the obturator.
• Check the needle for the absence of the implant. After
retraction of the cannula, the grooved tip of the obturator
should be visible (Figure 8).
• Always verify the presence of the implant by
palpation and also have the woman palpate it
herself.
• In case the implant cannot be palpated or when the
presence of the implant is doubtful, other methods must be
applied to confirm its presence. Suitable methods to locate
the implant are first of all ultrasound (USS) and secondly
magnetic resonance imaging (MRI). Prior to the application
of USS or MRI for the localization of IMPLANON, it is
recommended to consult MSD for instructions.
• In case these imaging methods fail, it is advised to verify the
presence of the implant by measuring the etonogestrel level
in a blood sample of the subject. In this case, MSD will also
provide the appropriate procedure.
• Until the presence of IMPLANON has been
confirmed, a contraceptive barrier method must
be used.
• Apply sterile gauze with a pressure bandage to prevent
bruising.
• Fill out the User Card and hand it to the patient to
facilitate removal of the implant later.
• The applicator is for single use only and must be adequately
disposed of, in accordance with local regulations for the
handling of biohazardous waste.
Localizing IMPLANON
• Localization is an essential component of the insertion
and removal process. Palpation is the first step in the
localization process.
Always localize by palpation:
– Immediately after insertion
– Immediately prior to removal
• If the implant is not palpable after insertion, confirm its
presence in the arm with imaging techniques (USS, MRI) as
soon as possible. The patient must use a back-up method
of contraception until the presence of IMPLANON has
been confirmed.
• Exploratory surgery for the purpose of removing
IMPLANON without knowledge of the exact location of
the implant is strictly discouraged.
• IMPLANON is not radiopaque and is not visible on X-ray
or CT images.
• Although IMPLANON is visible on MRI images, ultrasound
is the preferred imaging method because it is least invasive.
After localizing the implant using USS, removal can be
completed with the assistance of USS guidance.
• Characteristics of IMPLANON on USS:
–
Sharp acoustic shadow below the implant in the
transverse position
– Implant is a small echogenic spot (2 mm) when viewed in
the transverse position
• MRI - Implant appears as a hypodense area. It is especially
important to differentiate the implant from blood vessels.
How to Remove IMPLANON
• Removal of IMPLANON should be performed
only
by a
health care provider who is familiar with the procedure.
Prior to removal carefully read the full Prescribing
Information.
• Indications for removal
– Patient request
– Medical indication
– At the end of 3 years of use
• If the woman does not wish to become pregnant, another
contraceptive method should be started immediately
(return to normal menstrual cycle may be very rapid).
• Counsel the patient thoroughly prior to removal of
IMPLANON.
• A non-palpable implant should always first be localized by
either USS or MRI before removal is attempted. In case
of doubt, the presence of IMPLANON can be verified by
etonogestrel determination.
• Exploratory surgery without knowledge of the exact
localization of the implant is strictly discouraged. Removal of
deeply inserted implants should be conducted with caution
in order to prevent damage to deeper neural or vascular
structures in the arm and be performed by health care
providers familiar with the anatomy of the arm.
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