Hormonal IUD (LNG-IUS) Insertion Technique

this video focuses on the two-handed

insertion of the hormonal IUD a

long-acting reversible contraceptive it

is safe for almost all women and over

99% effective at preventing pregnancy

for this IUD insertion you will need

these instruments and supplies hormonal

IUD in its sterile packaging gloves

uterine sound either disposable plastic

or metal tenaculum speculum blunt tip

scissors and antiseptic solution and


prior to any IUD insertion you should

perform a bimanual exam to confirm the

shape size and direction of the uterus

insert the speculum

and clean the cervix two to three times

with the antiseptic solution

next apply the tenaculum to the cervix

at the 12 o'clock position use the

tenaculum to gently apply traction to

align the cervical canal and uterine

cavity then insert the uterine sound to

measure the depth of the fundus

now that we have sounded the uterus we

can prepare the IUD for insertion first

let's review the parts of the insertion

package insertion tube flange IUD IUD

strings rod ring of Rod first top and

second bottom indents

keeping the IUD in its sterile package

place the IUD packet on a flat surface

and open from the bottom only one-third

of the way up pick up the threads to

remove them from the flange and hold the

threads and insertion tube with one hand

use the other hand to remove the rod

from the package and insert it into the

insertion tube until the tip of the rod

is at the 5 centimeter marker

hold the inserter tube and rod firmly

between the thumb and the index finger

with the other hand grasp the threads

and pull the IUD down slowly into the

insertion tube until the nobs of the

lateral arms cover the distal opening of

the tube forming a hemispherical dome at

the top keep a firm hold on the tube and

rod to maintain position the top of the

rod should be touching the bottom of the

IUD and the bottom of the tube should

align with the first indent of the rod

through the sterile package set the blue

flange so that the upper edge

corresponds to the sounded measurement

of the uterus ensure that the flange is

perpendicular to the arms of the IUD

maintain a firm hold on the tube and rod

and remove the loaded IUD insertion tube

from the package

gently align the cervical canal again

with the tenaculum then slide the loaded

IUD through the cervical canal stop when

the upper end of the flange is 1.5 to 2

centimeters away from the cervix this

will leave enough room at the fundus for

the IUD arms to open in the next step do

not advance the flange to the cervix

next gently release your hold on the

tenaculum and grab the ring of the rod

to hold it steady to release the arms of

the IUD from the insertion tube gently

pull back the insertion tube to the

bottom second notch in the rod this

allows the arms of the IUD to expand in

the lower uterine segment

wait 10 to 15 seconds for the arms to

fully open while holding the insertion

tube and ride steady

you can now let go of the rod and once

again apply gentle traction to the

tenaculum next advance the insertion

tube and rod to the uterine fundus

stopping when you feel a slight

resistance at this point the flange

should be touching the cervix and the

IUD should be in place at the uterine

fundus next again gently release your

hold on the tenaculum and grab the ring

of the rod to hold it steady to release

the IUD from the insertion tube gently

pull the insertion tube back to the ring

of the rod

you should feel a pop when the IUD comes

out of the insertion tube holding the

insertion tube steady withdraw the rod

from the insertion tube all the way out

to prevent it from catching on the knot

at the lower end of the IUD this could

result in the IG being dislodged then

remove the insertion tube

finally trim the strings with scissors

leaving three centimeters of string

outside of the cervix again take care

not to pull the strings or the IUD may

become displaced

release the tenaculum from the cervix

ensuring hemostasis at the tenaculum

sites and remove the speculum once the

IUD has been placed remind the patient

of warning signs of complications when

to return for a check-up and when the

ided should be removed let us briefly

review the key points of the insertion

of a hormonal IUD