Implant

Question 1

Measurement?

Answer 1

40mm x 2mm

68mg ENG

Question 2

COC to Implant when is only time need 7 day cover?

Answer 2

d3-7 HFI or week 1

Question 3

DSG to implant when do you need 7 days cover?

Answer 3

Never (if correct use)

Question 4

Net to implant when 7 days?

Answer 4

Always

Question 5

Depo to implant when do you need cover?

Answer 5

Only if >14 weeks

Question 6

How many assessment criteria are there for LOC IR?

Answer 6

8 and all must be satisfactory to be competent overall

Question 7

What is max 1% lidocaine FSRH say for insertion and removal?

Answer 7

3ml insertion
1ml removal

Max safe dose is 20ml

Question 8

Incidence of intravascular migration <1:million

Answer 8

True

Advise pt that distant migration (>2cm) or intravascular are rare

Question 9

Are implants affected by enzyme inducing drugs?

Answer 9

Yes. Effectiveness may be reduced during use and for 28 days after.

Question 10

What do FSRH say re Implant & BMD?

Answer 10

Evidence too limited to exclude or confirm

Question 11

What do FSRH say re bleeding mgt on implant?

Answer 11

5 days mf. Acid
3/12 cocp
No evidence re POP

Question 12

Can switch to coil in year 4 implant even if UPSI last 21/7?

Answer 12

Yes
Failure rate v low even in 4th year and likely similar to eg pill
Still advise PT in 21/7

Question 13

Why can’t you advise routine use of implant 4 years? If ok to insert a coil and not give EC?

Answer 13

Users expect high efficacy.

Cannot guarantee as good as yrs 1-3

Likely as good as typical use eg pill

Question 14

What if get pregnant with implant in?

Answer 14

Established practice to remove but no evidence teratogenic

If abortion can leave in if pt happy/not expired and extrapolated evidence suggest no impact on efficacy mifepristone

Question 15

What ukmec are previous breast cancer, stroke on implant, IHD on implant, decompensated cirrhosis, liver adenoma or cancer, unexplained PVB?

Answer 15

Ukmec 3

Risk generally outweighs benefit. Could use if no other suitable methods

Question 16

What is current breast cancer ukmec?

Answer 16

4

Question 17

What is best practice starting implant re any tests? Key history?

Answer 17

BP (for any method-not essential but good practice)

Weight may help if concern re change on method.

STI asses risk/offer screen if relevant

Drug interactions are key

Question 18

Why is implant ukmec 3 if have an arterial clot or mi with it in?

Answer 18

No evidence in population who have already had an event.

Evidence have relates to general population (and suggest no increased risk CVd or mi)

Question 19

Why do we insert posterior to sulcus?

Answer 19

Theoretical less risk neurovascular injury (in cadavers were less big nerves/vessels posterior to sulcus than there were anterior)

Question 20

What day after childbirth do you need to advise 7 days condoms and consider EC insertion implant

Answer 20

Day 21 or more

Abortion it is Day 6 or more ie after d5

Question 21

What does flex elbow do at insertion?

Answer 21

Pulls ulnar nerve towards sulcus and hopefully out of way

Question 22

If replacing implant in correct site can you put it in along established track?

Answer 22

No-can use same incision but established practice is to make fresh track

Question 23

If in date implant switch to lng ius when is it effective?

Answer 23

Immediately.

Presume as rely on maintenance of effect on cervical mucus….

Note is same for switching to any hormonal method (or to cu iud) from an in date implant

Question 24

How long do FSRH say ethyl chloride spray works?

Answer 24

60 secs

Question 25

What do FSRH say about insertion/removal in bleeding disorders or on VTE treatment or prophylaxis eg warfarin/DOAC/LMWH

Answer 25

Don’t stop VTE/ATE meds as risk VTE-think about timing and avoid nsaid analgesia

Plt > 50 fine.

Question 26

What is incidence nerve damage post insertion or removal?

Answer 26

Robust data do not exist.

Case reports suggest injury to ulnar nerve most common at insertion

Median/cutaneous/ulnar at removal

Question 27

What US frequency needed to confirm implant?

Answer 27

High frequency linear probe 10mhz or greater

Question 28

What to do broken implant?

Answer 28

Advise manufacturer say no reduction in efficacy-pt preference/clinical judgement

Question 29

Which implants are two rod?

Answer 29

Jaydelle (5yr) and Sino (4yr) both LNG

Question 30

What implant had 6 rods?

Answer 30

Norplant (5yr) LNG

Question 31

Which implants are radiopaque?

Answer 31

Nexplanon and Jaydelle

Nexplanon has barium Jaydelle does not so can use X-ray CT or US and MRI

Implanon is not so need to use MRI or US only