New advice regarding placement position for Implanon NXT

The contraceptive implant (Implanon NXT) is one of the most effective contraceptives available. Along with the hormonal and copper IUDs, it is classified as Long Acting Reversible Contraception (LARC) which are recommended as first-line options for all people choosing to use contraception. SHQ wish to alert clinicians to important updated information about Implanon NXT procedures following an update of the product information in January 2020.

These changes have been made to avoid the large blood vessels and nerves within and around the sulcus between biceps and triceps and reflect published research https://doi.org/10.1016/j.contraception.2019.02.007

The key updates:

• Patient positioning: The patient’s arm should be flexed at the elbow with the hand underneath the head (or as close as possible).
• Insertion site: 3-5cm posterior to the sulcus between biceps and triceps muscles, 8-10cm proximal to the medial epicondyle, in the non-dominant arm. It is recommended to measure and mark the insertion site. If it is not possible to insert the implant 3-5cm from the sulcus (eg. a person with thin arms) it should be inserted as far from the sulcus as practical.
• Replacement (removal and re-insertion) site: Position the patient’s arm as described above. The new implant may be inserted in the same arm, and through the same incision if the insertion site is in the correct position. Otherwise site the new implant as per the above insertion site information.
• Removal of non-palpable implants: If the implant cannot be found in the arm after comprehensive local imaging, consider imaging of the chest as rare events of migration to the pulmonary vessels have been reported.

Videos demonstrating the correct procedure techniques are available online at www.implanonnxtvideos.com

Although this advice has not changed, we remind you that for implant removals that the incision should be parallel to the implant at the distal end, and not perpendicular.

All clinicians are strongly advised to undergo Implanon NXT training prior to performing procedures. Training is available at SHQ.