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LNG-IUS Placement

In general, a ‘No-touch’ technique (everything entering the cervix should be sterile and should not be touched) should be performed. Non-sterile gloves may be used provided nothing inserted beyond the cervix is touched.

The general steps of IUS placement are as follows:

  1. Perform a bimanual exam to assess uterine size and position
  2. Insert the speculum
  3. Tenaculum placement
    • To reduce the angle of uterine axis, reduce difficulty of placement, and possibly reduce the risk of perforation, we strongly recommend the use of a tenaculum.
  4. Sound the uterus, using a dilator if necessary prior to sounding.
    • DO NOT open the IUS package until you have sounded the uterus successfully
  5. Insert the IUD as per product monograph (below)
  6. Trim the strings 3-10 cm from the external cervical os

SOGC: Quick reference on IUC insertion

Uterine Sounding

  • It is a critically important step that should not be avoided.
  • If you have sounded to <6cm, do not insert the IUS as you have likely not sounded to the fundus of the uterus
  • If you have sounded beyond 10 cm or there is no resistance felt, STOP and consider perforation.

Fast Facts

Sound BEFORE opening IUD/IUS packaging to avoid contamination and delay in obtaining a replacement if a second attempt for placement is required.

7 Steps to sounding the Uterus

  1. Insert speculum to visualize the cervix
  2. Cleanse the cervix and vagina with antiseptic (optional)
  3. Apply tenaculum to the cervix (using anaesthetic if indicated)
  4. Gently pull the tenaculum to align the uterus, cervical opening and vaginal canal
  5. Insert the sterile sound into the vagina and through the cervical opening. Warn the woman about an increase in discomfort as the sound reaches 4 cm, or as the internal os is passed.
  6. Advance the sound into the uterine cavity until a slight resistance is felt (at the fundus)
  7. Withdraw the sound and determine depth of uterus by direct visualization

IUS (Mirena, Jaydess, Kyleena) Placement

  • Load the IUS: Push the green (Mirena) or pink (Jaydess) or grey (Kyleena) slider on the handle forward so that the arms of the IUS are enclosed in the insertion tube.
  • Set the upper edge of the flange to correspond to the sound measurement
  • Insert until the flange is 1.0 cm from the cervix
  • Pull back on slider to first mark (release arms)
  • Wait 10 seconds
  • Advance to fundus until the flange touches the cervix or you feel fundal resistance
  • Pull back the slider all the way to the end (release IUS)
  • Gently remove the inserter from the os (gentle rotation is sometimes done to ensure release)
  • Cut the threads, leaving 3-10 cm of string visible out of the cervix