Deep or Impalpable Contraceptive Implants
Referral Criteria for the Management of Deep or Impalpable Contraceptive Implants
Women presenting for removal of a contraceptive implant where the device is impalpable, deep enough to cause concern that standard removal will not be possible, or where there have been previous attempts at removal.
If the implant is impalpable, please consider pregnancy testing, advise use of additional contraceptive precautions and arrange x-ray of the arm (for Nexplanon) or ultrasound to determine if the device is present. If the device is not seen on x-ray a CXR is also recommended in case of intravascular migration. An impalpable implant will require referral to Plymouth for ultrasound guided removal. Referrals for impalpable implants go to:
Dr Dianna Sells
Community Contraception and Sexual Health
Plymouth, Devon PL1 4JZ
If the device can be felt but is deep or there has been a previous unsuccessful attempt at removal they can be referred to RCH Sexual Health Services where they will be assessed by a Senior Contraception Doctor who will attempt removal if appropriate or arrange onward referral if required.
Information to Include when referring:
Duration of use
Where and by whom it was fitted
Results of any x rays or scans
Faculty of Sexual and Reproductive Healthcare Clinical Guidance. Progestogen Only
Implants February 2014