Managing deep insertion of an etonogestrel implant

If the etonogestrel implant is inserted too deeply (eg into a muscle or into a blood vessel), there is a risk of implant migration.

A palpable deeply placed implant should only be removed by an experienced practitioner.

If the implant is not palpable (either at the time of planned removal or any time earlier), the implant should be removed because there is a risk of implant migration. Arrange an X-ray to confirm the implant is present and refer for specialist removal under real-time ultrasound guidance. Additional contraception should be used until presence of the implant is confirmed. If the implant is not visible on imaging, contact the manufacturer for advice on imaging of the upper chest; extremely rare cases of migration to the pulmonary vasculature have been reported. Serum etonogestrel concentration may be helpful if imaging does not locate the implant; it is not available in Australia but can be organised by the implant manufacturer.