Is a Peripherally Inserted Central Catheter (PICC) line left in place between Lutetium-177 (LU-177) infusions?

Management of PICC Lines Between LU-177 Infusions

PICC lines should be left in place between LU-177 infusions to minimize complications and improve treatment efficiency.

Rationale for Maintaining PICC Lines Between Infusions

The decision to leave a PICC line in place between LU-177 infusions is supported by several key considerations:

1. Treatment Protocol Requirements:

   • LU-177 therapy typically involves multiple infusions over time, making repeated vascular access necessary
   • Peripherally inserted central catheters (PICCs) are specifically recommended for LU-177 radiopharmaceutical therapy 1

2. Duration-Based Recommendations:

   • For treatments lasting 15 or more days (which applies to most LU-177 therapy regimens), PICCs are the preferred vascular access device 1
   • For therapies requiring multiple infusions over extended periods, maintaining the same access reduces complications

3. Clinical Experience with LU-177:

   • Transitioning from peripheral IV lines to PICC lines for LU-177 therapy has been shown to reduce complications 2
   • In a clinical study, no PICC complications were observed when using PICC lines for LU-177 administration, compared to a 16.7% complication rate with peripheral IV lines 2

Benefits of Maintaining PICC Lines

• Reduced Complications: Eliminates the risk of repeated insertion trauma and associated complications
• Improved Patient Experience: Avoids repeated painful procedures for line placement
• Treatment Efficiency: Ensures reliable vascular access for scheduled treatments
• Reduced Extravasation Risk: Central venous access reduces the risk of extravasation of radioactive material, which is a significant concern with LU-177 therapy 3

Considerations for PICC Line Management

1. Line Care Between Treatments:

   • Regular flushing with saline and/or heparin according to institutional protocols
   • Regular dressing changes and site assessment for signs of infection or complications
   • Patient education on PICC line care and when to seek medical attention

2. Monitoring for Complications:

   • Evaluate the catheter insertion site daily for signs of phlebitis (warmth, tenderness, erythema, palpable venous cord) 4
   • Monitor for signs of catheter-related bloodstream infection
   • Assess for catheter occlusion or displacement

3. Special Populations:

   • For patients with chronic kidney disease stage 3b or greater (eGFR <45 mL/min), consider tunneled central venous catheters instead of PICCs to preserve veins for potential future hemodialysis access 4

When to Consider Removal or Replacement

While maintaining PICC lines between infusions is generally recommended, consider removal or replacement in these situations:

• Infection: Signs of catheter-related infection require prompt assessment and possible removal
• Catheter dysfunction: Occlusion, displacement, or damage to the catheter
• Extended time between treatments: If the interval between treatments exceeds several weeks to months, risk-benefit assessment should be performed
• Completion of therapy: Remove the PICC line when the full course of LU-177 therapy is completed

Conclusion

Based on the available evidence, PICC lines should be maintained between LU-177 infusions to ensure reliable vascular access, reduce complications associated with repeated insertions, and improve patient comfort. This approach is supported by clinical experience with LU-177 therapy 2 and aligns with guidelines for vascular access device selection for therapies requiring multiple infusions over extended periods 1, 4.