Implant Flashcards
Measurement?
40mm x 2mm
68mg ENG
COC to Implant when is only time need 7 day cover?
d3-7 HFI or week 1
DSG to implant when do you need 7 days cover?
Never (if correct use)
Net to implant when 7 days?
Always
Depo to implant when do you need cover?
Only if >14 weeks
How many assessment criteria are there for LOC IR?
8 and all must be satisfactory to be competent overall
What is max 1% lidocaine FSRH say for insertion and removal?
3ml insertion
1ml removal
Max safe dose is 20ml
Incidence of intravascular migration <1:million
True
Advise pt that distant migration (>2cm) or intravascular are rare
Are implants affected by enzyme inducing drugs?
Yes. Effectiveness may be reduced during use and for 28 days after.
What do FSRH say re Implant & BMD?
Evidence too limited to exclude or confirm
What do FSRH say re bleeding mgt on implant?
5 days mf. Acid
3/12 cocp
No evidence re POP
Can switch to coil in year 4 implant even if UPSI last 21/7?
Yes
Failure rate v low even in 4th year and likely similar to eg pill
Still advise PT in 21/7
Why can’t you advise routine use of implant 4 years? If ok to insert a coil and not give EC?
Users expect high efficacy.
Cannot guarantee as good as yrs 1-3
Likely as good as typical use eg pill
What if get pregnant with implant in?
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
What ukmec are previous breast cancer, stroke on implant, IHD on implant, decompensated cirrhosis, liver adenoma or cancer, unexplained PVB?
Ukmec 3
Risk generally outweighs benefit. Could use if no other suitable methods
What is current breast cancer ukmec?
4
What is best practice starting implant re any tests? Key history?
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
Why is implant ukmec 3 if have an arterial clot or mi with it in?
No evidence in population who have already had an event.
Evidence have relates to general population (and suggest no increased risk CVd or mi)
Why do we insert posterior to sulcus?
Theoretical less risk neurovascular injury (in cadavers were less big nerves/vessels posterior to sulcus than there were anterior)
What day after childbirth do you need to advise 7 days condoms and consider EC insertion implant
Day 21 or more
Abortion it is Day 6 or more ie after d5
What does flex elbow do at insertion?
Pulls ulnar nerve towards sulcus and hopefully out of way
If replacing implant in correct site can you put it in along established track?
No-can use same incision but established practice is to make fresh track
If in date implant switch to lng ius when is it effective?
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
How long do FSRH say ethyl chloride spray works?
60 secs
