Update on Nexplanon insertion site
Date: 15 Jan 2020
Type: FSRH Clinical Guidance and Clinical Statements
The manufacturer of Nexplanon® has today (Merck Sharp & Dohme Limited, 15/01/2020) issued updated guidance regarding the recommended Nexplanon insertion site.
The guidance is based on a recent manufacturer-funded study2 in which cadaveric arms were dissected. The study identified the site on the inner upper arm at which there are fewest underlying neurovascular structures and thus least theoretical risk of Nexplanon insertion/removal-related neurovascular damage or intravenous insertion.
It is noted that there are no robust real life clinical data to inform the site at which, in clinical practice, there is least risk of significant complication at Nexplanon insertion or removal. FSRH CEU acknowledges that there remain different opinions about the most suitable Nexplanon insertion site.
However, to reflect the findings of the anatomical study and avoid further conflicting guidance, FSRH opts to support the manufacturer recommendation. This represents a change in FSRH guidance.
Nexplanon insertion (and removal) should only be carried out by appropriately trained healthcare professionals. The manufacturer has produced materials to clarify the recommended insertion site and technique and to support those who have been trained to insert Nexplanon at a different site.
We will be producing further training materials. FSRH-trained Nexplanon inserters trained to insert Nexplanon over biceps may choose to continue to do so until they are competent and confident in identifying the new insertion site, ensuring as always that insertion is superficial and avoids the sulcus.