ParaGard^® insertion is a relatively simple process. Let's look at it step-by-step. The following loading and placement steps and accompanying streaming video clips from the ParaGard^® Insertion Training and Patient Counseling DVD offer a brief overview of ParaGard^® insertion. While this presentation covers the basics, we urge you to attend a live ParaGard^® insertion training session and watch our full Insertion Training DVD.

Please see the full Prescribing Information regarding preparations for insertion, warnings, contraindications, adverse reactions, and other important information concerning ParaGard^®.

To order a free copy of the full ParaGard^® Insertion Training and Patient Counseling DVD, click here.

To download a printer-friendly PDF of the Insertion Tent Card, click here.




Preinsertion Steps

• Establish the size and position of the uterus by pelvic examination
• Insert a speculum and cleanse the vagina and cervix with an antiseptic solution
• Apply a tenaculum to the cervix and use gentle traction to align the cervical canal with the
  uterine cavity
• Gently insert a sterile sound to measure the depth of the uterine cavity
• The uterus should sound to a depth of 6 to 9 cm except when inserting ParaGard^® immediately postabortion or postpartum
• Insertion of ParaGard^® into a uterine cavity measuring less than 6 cm may increase the incidence of expulsion, bleeding, pain, and perforation
• If you encounter cervical stenosis, avoid undue force; dilators may be helpful in this situation

Do not bend the arms of ParaGard^® earlier than 5 minutes before placement in the uterus. Use aseptic technique when handling ParaGard^® and the part of the insertion tube that will enter the uterus.

• Jump to:
• Step 2
• Step 3
• Step 4
• Step 5
• Step 6
• Step 7
• Removal

Load ParaGard^® into the insertion tube by folding the two horizontal arms of ParaGard^® against the stem and push the tips of the arms securely into the inserter tube.

Use sterile gloves, or, if you prefer a "no-touch technique," you can do Steps 1 and 2 without gloves while ParaGard^® is in the sterile package. First, place the package face up on a clean surface. Next, open at the bottom end (where arrows say OPEN). Pull the solid white rod partially from the package so it will not interfere with assembly. Place your thumb and index finger on top of the package on the ends of the horizontal arms. With your other hand, push the insertion tube against the ParaGard^® arms. This will start bending the T arms.

Bring your thumb and index finger closer together to continue bending the arms until they are alongside the stem. Use your other hand to withdraw the insertion tube just enough so that the insertion tube can be pushed and rotated onto the tips of the arms. Your goal is to secure the tips of the arms inside the tube. Insert the arms no further than necessary to ensure retention. Introduce the solid white rod into the insertion tube from the bottom, alongside the threads, until it touches the bottom of the ParaGard^®.

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Grasp the insertion tube at the open end of the package. Adjust the blue flange so that the distance from the top of the ParaGard^® (where it protrudes from the inserter) to the blue flange is the same as the uterine depth that you measured with the sound. Rotate the insertion tube so that the horizontal arms of the T and the long axis of the blue flange lie in the same horizontal plane. Now pass the loaded insertion tube through the cervical canal until ParaGard^® just touches the fundus of the uterus. The blue flange should be at the cervix in the horizontal plane.

To release the arms of ParaGard^®, hold the solid white rod steady and withdraw the insertion tube no more than 1 centimeter. This releases the arms of ParaGard^® high in the uterine fundus.

Gently and carefully move the insertion tube upward toward the top of the uterus, until you feel slight resistance. This will ensure placement of the T at the highest possible position
within the uterus.

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Hold the insertion tube steady and withdraw the solid white rod.

Gently and slowly withdraw the insertion tube from the cervical canal. Only the threads should be visible protruding from the cervix. Trim the threads so that 3 to 4 cm protrude into the vagina. Note the length of the threads on the patient's chart.

If you suspect that ParaGard^® is not in the correct position, check placement (with ultrasound if necessary). If ParaGard^® is not positioned completely within the uterus, remove it and replace it with a new ParaGard^®. Do not reinsert an expelled or partially expelled ParaGard^®.

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CAUTION
Instrumentation of the cervical os may result in vasovagal reactions, including fainting.
Have the patient remain supine until she feels well and have her get up with caution.
Please see full Prescribing Information regarding continuing care.


Remove ParaGard^® with forceps, pulling gently on the exposed threads. The arms of ParaGard^® will fold upwards as it is withdrawn from the uterus. You may immediately insert a new ParaGard^® if the patient requests it and has no contraindications.

Embedment or breakage of ParaGard^® in the myometrium can make removal difficult. Analgesia, paracervical anesthesia, and cervical dilation may assist in removing an embedded ParaGard^®.
An alligator forceps or other grasping instrument may be helpful. Hysteroscopy may also be helpful.