US referral center experience removing nonpalpable and difficult contraceptive implants with in-office ultrasonography: A case series

Mastey, Namrata; Matulich, Melissa C.; Uhm, Suji; Baker, Courtney C.; Melo, Juliana; Chen, Melissa J.; Creinin, Mitchell D.

doi:10.1016/j.contraception.2021.01.018

Cited by 8 publications

(12 citation statements)

References 8 publications

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“…Three case series describe referral center experience with nonpalpable implant removal. 73–75 In these case series, approximately 90% of people referred were confirmed to have a nonpalpable implant. Almost all implants were able to be localized by high-frequency ultrasonography, with few requiring other imaging modalities.…”

Section: Removal Challengesmentioning

confidence: 99%

Long-Acting Reversible Contraception

Baker

Creinin

2022

Obstetrics &Amp; Gynecology

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Section: Removal Challengesmentioning

confidence: 99%

Long-Acting Reversible Contraception

Baker

Creinin

2022

Obstetrics &Amp; Gynecology

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“…2 The device is typically removed in an outpatient setting by manipulating the rod out of a perpendicular incision made at the distal end of the implant after injection of local anesthetic. When the practitioner cannot successfully remove the implant, however, the patient may be referred to a specialized center with family planning expertise 3,4 or an upper extremity surgeon for surgical removal. 2 Prior case reports have described proximal migration of the device into the axilla, 5 in the deep compartments of the arm, and even into pulmonary vasculature.…”

Section: Introductionmentioning

confidence: 99%

“…9 In addition, identifying anatomic landmarks of the upper extremity can be challenging in patients with obesity, 10 which may negatively impact insertion technique and palpation for removal. While there are data to support referral of difficult removals to fellowship-trained family planning providers, 3,4 there is a lack of literature characterizing patients that have been referred to plastic and orthopedic surgeons for etonogestrel subdermal implant removal. 11 The purpose of this case-control study is to compare patients undergoing surgical removal of etonogestrel subdermal implants with patients who undergo uncomplicated in-office removal.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Patients Requiring Surgical Removal of Subdermal Contraceptive Implants: A Case–Control Study

Katabi¹,

Stevens²,

Ascha³

et al. 2022

OAJC

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Etonogestrel subdermal implants are a commonly used contraceptive device placed in the medial upper arm. Plastic and orthopedic surgeons may be consulted for difficult implant removals. We performed a case-control study comparing patients undergoing surgical and uncomplicated in-office removal at our institution. Patients and Methods: We identified patients who underwent operative removal of implantable contraceptive devices by plastic or orthopedic surgeons at our institution from January 2014 to October 2019. Patients who underwent uncomplicated office removal during the same time were compared. Demographic and surgical variables were collected, and descriptive statistics were calculated. Univariate and multivariate logistic regression was performed with surgical versus outpatient removal as the outcome of interest. Results: A total of 669 patients undergoing etonogestrel subdermal implant removals were identified during the five-year study period, of which thirteen patients required surgical removal (1.9%) and 326 were selected as uncomplicated removal comparisons. There were no significant differences in median (IQR) body mass index (BMI) (31.1 [28.2, 35.2] versus 29.3 [24.0, 35.1], p = 0.19), median (IQR) weight gain since device placement (5 [−0.6, 14.7] kilograms versus 1.6 [−1.2, 5.8] kilograms, p = 0.15), or length of time since device insertion (2.3 [0.8, 2.8] years versus 1.0 [0.4, 2.2] years, p = 0.17). Of those who needed surgical removal, the most common indication for implant removal was device expiration (n = 5, 38.5%). Devices placed by OBGYN attendings were less likely to require surgical removal (p = 0.02). Family medicine attendings were more likely to refer patients for surgical removal (p = 0.02). No significant findings were detected on univariate or multivariate regression. Among surgical removals, radiography was the most frequently used imaging modality. Implants were most frequently subdermal (n = 11, 84.6%) though intramuscular placement was also identified (n = 2, 15.4%). Only one patient had residual paresthesia along the length of the incision. No other complications were identified. Conclusion:We did not identify risk factors associated with the difficult removal of etonogestrel subdermal implants. Practitioners should consult upper extremity surgeons if they encounter difficult removals.

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“…In 2010, the manufacturer introduced a new single-handed inserter and added 15 mg barium sulfate to the rod to allow radiopacity [2]. Instructions for subdermal implant insertion have changed over the past decade, primarily inspired by rare complications related to deep insertions, including intravascular placement and pulmonary artery migration [3][4][5][6]. Initially the manufacturer suggested insertion into the sulcus between biceps and triceps muscle.…”

Section: Introductionmentioning

confidence: 99%

“…Ultrasound is the most widely used technique [5,6], but the addition of barium sulfate also allows radiography as an easier first option for localization [7].…”

Section: Introductionmentioning

confidence: 99%

Removal of nonpalpable etonogestrel implants after fixation with a curved needle—A case series,

El-Hadad

Villars²,

Kahr

et al. 2021

Contraception

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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US referral center experience removing nonpalpable and difficult contraceptive implants with in-office ultrasonography: A case series

Cited by 8 publications

References 8 publications

Long-Acting Reversible Contraception

Long-Acting Reversible Contraception

Characteristics of Patients Requiring Surgical Removal of Subdermal Contraceptive Implants: A Case–Control Study

Removal of nonpalpable etonogestrel implants after fixation with a curved needle—A case series,

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