Should I use a PICC (Peripherally Inserted Central Catheter) catheter or peripheral catheters for 6 LU-177 (Lutetium-177) infusions with 6 weeks between infusions?

Venous Access for LU-177 Infusions: PICC vs. Peripheral Catheters

For 6 LU-177 infusions scheduled 6 weeks apart, a PICC line is strongly recommended over peripheral catheters to ensure safe administration and minimize complications. 1

Rationale for PICC Line Selection

Duration of Therapy Considerations

• The total treatment course spans approximately 30 weeks (6 infusions at 6-week intervals)
• According to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC):
  • PICCs are preferred when the proposed duration of infusion is 15 or more days 1
  • For episodic infusions over several months (as in this case), PICCs or other long-term devices are appropriate 1

Medication Characteristics

• LU-177 (Lutetium-177) is a radiopharmaceutical agent used in targeted radionuclide therapy
• It should be considered a non-peripherally compatible infusate (similar to chemotherapy agents)
• For infusion of irritants or vesicants such as chemotherapy, PICC use is rated as appropriate at any proposed duration 1

Advantages of PICC for This Treatment Regimen

1. Vein preservation:

   • Reduces trauma from multiple peripheral venipunctures over the extended treatment course 2
   • Particularly important for patients receiving multiple cycles of therapy

2. Safety profile:

   • Lower risk of extravasation for radiopharmaceuticals
   • Reduced risk of complications compared to other central venous access devices 2
   • Appropriate for medium to long-term therapy (6 weeks to 6 months) 3

3. Convenience:

   • One PICC can provide adequate access throughout the entire treatment course 3
   • Eliminates need for repeated peripheral venipunctures at each infusion
   • Easier maintenance between treatments compared to peripheral catheters

Potential Alternative Options

For patients where a PICC is contraindicated:

• Tunneled central venous catheter or implanted port:
  • Appropriate for therapy ≥31 days 1
  • Consider for patients with chronic kidney disease (eGFR <45 mL/min) to preserve veins 4

Monitoring and Maintenance Between Infusions

• Evaluate the catheter insertion site regularly for signs of phlebitis (warmth, tenderness, erythema) 4
• Follow institutional protocols for flushing and maintenance of PICC lines between treatments
• Consider PICC removal only after completion of all planned infusions unless complications develop

Important Considerations

• Contraindications: Assess for history of thrombosis or unsuitable veins before PICC placement 1
• Placement verification: Confirm proper PICC tip position via radiological methods or ECG-guided placement 5
• Complication monitoring: Regular assessment for infiltration/extravasation, phlebitis, catheter occlusion, and infection 4

Pitfalls to Avoid

• Do not use peripheral catheters for LU-177 administration due to:

  • Risk of extravasation with radiopharmaceuticals
  • Need for repeated venipunctures over extended treatment course
  • Peripheral catheters are inappropriate for non-peripherally compatible infusates 1

• Do not delay PICC placement until later in the treatment course:

  • Early placement preserves veins and provides consistent access
  • Reduces patient discomfort from multiple venipunctures