Factors associated with removal difficulties of etonogestrel-containing contraceptive implants (Nexplanon®)

Society of Family Planning clinical recommendation: Extended use of long-acting reversible contraception

“…Ali et al reported approximately 2% of etonogestrel implant users, which included 6% of patients with an BMI above 30, had slightly difficult or difficult removals at the end of the 5 years [17] . Chevreau et al concluded that longer use ( > 25 months) was independently associated with difficult removal (RR 2.91) which was defined as having a previous failed removal attempt [37] . Ultrasound was performed prior to removal and found that 24% of the people in the difficult removal group had an implant placed below the sub-brachial fascia.…”

Advanced implantable drug delivery technologies: transforming the clinical landscape of therapeutics for chronic diseases

“…Equally important, the presence of the device must always be verified immediately after insertion to circumvent implant migration. There are reports of difficulty removing Implanon®/Nexplanon® devices associated with peripheral nerve injury and implant migration (Barlow-Evans et al 2017;Chevreau et al 2018;Chung et al 2017;Diego et al 2017;Guiahi et al 2014;Laumonerie et al 2018;Odom et al 2017). Regardless, the benefits are indisputable given the high efficacy rate and that most common adverse effects reported for these implants include erythema, hematoma, application site pain, and edema are quick to resolve (FDA Reference IDs: 2887911; 3080389; 4099967; 4100681; 4215185) (Davis et al 2014;Donnelly et al 2015;Fisher et al 2014;Itzoe and Guarnieri 2017;Pedroso et al 2015;Serati et al 2015;Shumer et al 2016;Silverman et al 2015;Simon et al 2016;Smith et al 2017).…”

Migration of etonogestrel contraceptive implants: Implications for difficult removals services need in southern Africa

“…Poor insertion technique, usually too deep or at an incorrect site, [3,5] often results in implants being difficult to remove, as well as in their migration. [6] However, even with correct insertion, implant migration is still possible, and substantially migrated implants often require specialist services for safe and effective removal.…”