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EDUCATION & TRAINING

IMPLANON INSERTION STATEMENT

Statement regarding advice around Implanon insertion

Information for consumers:

There is currently some differing advice around the best location on a woman’s arm for Implanon insertion. SHQ recommends that implants should be placed very superficially and that women should discuss the location of the implant with their healthcare professional prior to insertion. More information about Implanon.

Information for clinicians:

There is a discrepancy between the advice from MSD and the Clinical Effectiveness Unit (CEU) statement by the Faculty of Sexual and Reproductive Health (FSRH) regarding contraceptive implant insertion site.

The CEU statement, released in June 2016, advises the following:

“The CEU supports the manufacturer’s advice that Nexplanon [called Implanon NXT® in Australia] insertion should avoid the sulcus between biceps and triceps. Further to this, the CEU recommends insertion over the biceps muscle anterolateral to the sulcus to avoid damage to the ulnar nerve which runs posteromedial to the sulcus.”

MSD’s proposed Australian training package, and letter to clinicians approved by the TGA, directs clinicians to insert the implant over the triceps muscle, 8-10 centimetres from the medial epicondyle. Anatomically, approximately 8-10cm proximal to the medial epicondyle, the ulnar nerve pierces the medial intramuscular septum to enter the posterior compartment of the brachium. Here the nerve lies on the anterior border of the medial head of the triceps. It passes behind the medial epicondyle (in the cubital tunnel) at the elbow where it is exposed for several centimetres.

SHQ advocates for the use of Long Acting Reversible Contraceptives (LARCs) as they are effective, affordable and safe if inserted correctly. Clinicians should be aware that the new position advocated by MSD places the ulnar nerve at risk of injury, and we advise that this should be discussed with patients. We advise clinicians to focus on placing the contraceptive subdermally, and to avoid the sulcus.

SHQ is awaiting international and evidence-based consensus regarding the ideal site for implant insertion prior to changing current practice to that recently recommended by MSD.

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