Contraceptive implant can it move

After completing an ultrasound, they found the implant was not in her arm, but in her left lung where it had migrated. To remove the implant, doctors used a video-assisted surgery to locate the object and then they did surgery in her chest area to remove the implant.

The woman was discharged from the hospital four days after surgery and had no complications, the doctors who treated her wrote in the case study. This phenomenon can happen if a doctor inserts the device too deep into a person's arm, according to the case study. Intense exercise could also result in an implant migration. In May , for example, doctors reported that a year-old woman's implant had moved to her lung. Although they couldn't pinpoint exactly why this happened, they believe the implant was inserted too deep and entered her vein , travelled through her body, and eventually reached her lung.

The subdermal contraceptive implant was not located by digital palpation or by ultrasound scanning of the insertion site.

X-ray evaluation of both humerus anterior and posterior was conducted and radiopaque foreign body was not detected. In addition, the long bone upper extremity standing anterior posterior lateral X-ray was performed, and it showed that about 4 cm length rod-like material is seen at the left lower thoracic area Fig.

Under the impression of foreign body at lower thoracic area, A non-contrast-chest computed tomography CT was performed, looking for a possible migration. It revealed that the foreign body was in left lower lobe of the lung probably in subsegmental pulmonary artery branch in left posterior basal segment Fig. The patient did not experience symptoms including chest discomfort or dyspnea while having the subdermal contraceptive implant.

After consultations with cardiology and chest thoracic surgery department, the foreign body removal through intervention was considered initially at the division of cardiology, department of internal medicine.

However, the foreign body was present in the lung parenchyme, and the decision was made to remove it through surgery at the department of chest thoracic surgery.

The patient was admitted to cardiothoracic department. Under general anesthesia, the patient was positioned in the right decubitus position during a surgery and a 6-cm minithoracotomy has performed at left intercostal space. Left lower lobe of lung was retracted using a long clamp and the site of foreign body was confirmed manually. Bovie cauterization was done to expose the foreign body and enucleation was performed immediately afterward. A 24 Fr-standard chest tube was inserted and the surgery was completed Fig.

The chest tube was removed on postoperative day 2. The patient was discharged from the hospital without complication. And further contraception plan was discussed at the outpatient clinic of the department of obstetrics and gynecology. The subdermal contraceptive implant is a long-active progestogen-only contraceptive method that contains 68 mg etonogestrel [ 6 ]. Another side effects include deep insertion, fibrous adhesion and broken implant, the prevalence of the side effects are estimated to be 1.

In our case, it is estimated that an inadvertent placement of the subdermal contraceptive implant into the basilic vein occurred during the initial procedure. The subdermal contraceptive implant migrated through the upper limb veins, stopping in the pulmonary artery branch in left posterior basal segment, then broke through the pulmonary artery branch and invaded the lung parenchyme.

When the subdermal contraceptive implant dislocated in pulmonary artery, intervention could be a method to remove it [ 8 ], but in this case thoracotomy was done due to difficult access. In previous case, it was attempted endovascular retrieval by selective catherization of pulmonary artery, using a gooseneck loop snare. After failing many times, hybrid operating room-guided video-assisted thoracoscopic surgery was conducted for removal [ 9 ].

Instructions for insertion state that subdermal contraceptive implant should be placed subdermally at the inner side of the upper nondominant arm about 7 cm above the elbow crease in the groove between the biceps and the triceps. The needle of the subdermal contraceptive implant inserter is introduced in the above-mentioned space, directly under the skin.

Because it is coated with barium sulphate, it is detactable on X-ray or CT [ 10 ]. It is inserted in the subcutaneous plane on the medial aspect of the nondominant arm, 8 to 0 cm proximal to the medial epicondyle under local anesthesia and should be palpable throughout its use.

Recommended removal is described in the product information, and is via a small subcutaneous incision at the distal end of the palpable rod, with the rod manually pushed through the incision and grasped with forceps as it appears. Notably, no dissection is required. In the case of the rod not being palpable it is recommended that ultrasound, X-ray, CT or magnetic resonance imaging be used to locate and remove the rod [ 11 ].

Previous studies show when the implant is inserted deep into soft tissue, the ultrasound is highly effective in assisting in the removal of impalpable [ 12 ]. The majority of impalpable implants were removed under local anesthetic with ultrasound control. The ultrasound-guided blunt dissection, in conjunction with a g spinal needle to lift and stabilize the midpoint of the implant, has been shown to be the most effective technique of removing the implants [ 13 ]. Complications with insertion and removal of subdermal contraceptive implant are rare in the hands of medical professionals familiar with the techniques and device, and these procedures should only be undertaken by those with relevant training.

In many cases, when the inserted implant is not palpable, it is located in muscle layer or soft tissue. Imaging studies including X-ray usually detect contraceptive implant placed subdermally in the upper arm but when the implant migrate form their initial implantation, an evaluation on lung and heart is necessary.

Measuring serum etonogestrel level should considered among implant users. Also, all women should be informed and consent to disadvantages including device dislocation, irregular vaginal bleeding, unexpected side effects inserting subdermal contraceptive implant. Please take me back. Yes, I am. This site is intended only for residents of the United States, its territories, and Puerto Rico.

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No fees have been received by Organon or paid to the HCPs for inclusion in this locator directory. You are ultimately responsible for the selection of an HCP and it is an important decision that you should consider carefully. This HCP locator is just one source of information available to you. Patient Information Prescribing Information. You should not use NEXPLANON if you are pregnant or think you may be pregnant; have or have had blood clots; have liver disease or a liver tumor; have unexplained vaginal bleeding; have breast cancer or any other cancer that is sensitive to progestin a female hormone , now or in the past; or are allergic to anything in NEXPLANON.

Talk to your healthcare provider about using NEXPLANON if you have diabetes, high cholesterol or triglycerides, headaches, gallbladder or kidney problems, history of depressed mood, high blood pressure, allergy to numbing medicines anesthetics or medicines used to clean your skin antiseptics. These medicines will be used when the implant is placed into or removed from your arm.

If you cannot feel the NEXPLANON implant, contact your healthcare provider immediately and use a non-hormonal birth control method such as condoms until your healthcare provider confirms that the implant is in place. You may need special tests to check that the implant is in place or to help find the implant when it is time to take it out. The implant may not be placed in your arm at all due to failed insertion.