Deep/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

 Cumberland Centre

 Damerel Close

 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









Frances Fuller

October 2017