Article Figures & Data
Figures
- FIGURE 1.
Prepared dedicated treatment room (A) and restroom (B).
- FIGURE 2.
(A and B) In-house–fabricated 30-mL syringe shield (with outer-to-inner arrows indicating adhesive bandage, lead layer, and acrylic layer). (C) Supplies to draw dose (wedge, syringe shield, gauze, alcohol wipes, 30-mL and 1-mL syringes, 3.5-in [8.9-cm] spinal needle and 20-gauge needles, and chux pad).
- FIGURE 3.
Dose preparation: insertion of vent needle and spinal needle for drawing up dose, with vial tilted on wedge, behind L-block in biologic safety cabinet, and with dedicated 177Lu waste bucket in back.
- FIGURE 4.
Dose administration supplies: Alaris pump with amino acids, saline bag, shielded Graseby pump, and 177Lu-DOTATATE on chux pad–covered cart.
- FIGURE 5.
Amino acid/177Lu-DOTATATE infusion worksheet for technologists.
- FIGURE 6.
Amino acid/177Lu-DOTATATE infusion worksheet for nurses.
- FIGURE 7.
Dana-Farber Cancer Institute nuclear medicine team. (Back row, left to right) Umesh Mukkuzhi, MS, CNMT, RT(N)(CT), Amanda Abbott, MS, CNMT, RT(N)(CT), PET, Lauren Gilbert, CNMT, RT(N)(CT), and Timothy Belisle, CNMT, RT(N)(CT). (Middle row, left to right) Michele Iacobucci, Yuji Kuzuhara, MHA, RT(N)(MR)(CT), CNMT, Jennifer Manganella, CNMT, RT(N)(CT), and Justin Tremont, CNMT, RT(N)(CT), PET. (Front row, left to right) Christopher Sakellis, MD, Annick D. Van den Abbeele, MD, FACR, Eileen Vo, RT(N), Heather Jacene, MD, and Marta Adamkiewicz, CNMT, RT(N). (Not pictured) Theresa Carroll, RT(N)(CT), Oswaldo Delgado, CNMT, Johnny Madrid, CNMT, NMTCB(CT), James Wellemeyer, RT(N), Aida Arthur, RN, Marianne Castano, MS, RN, Marion Fallon, RN, Leslie Hajjar, RN, Betsy Mele, RN, and Mary Jane Murphy, RN.
Tables
Staff member Role or responsibility Required training Medical oncology member Communicates with nuclear medicine team on eligible patients Workflow training Enters orders in electronic health record for 177Lu-DOTATATE procedure and required medications Eligibility training Evaluates patients within week before each 177Lu-DOTATATE treatment and monitors for adverse events afterward Pharmacist Provides antiemetics, amino acids, and posttreatment long-acting somatostatin analog on treatment day Workflow training Radiation safety officer Provides 177Lu radiation safety training to nuclear medicine staff Workflow training Prepares treatment room and restroom with contamination control measures; provides radiologic survey support as needed Collects residual or unused doses and associated contaminated materials and manages inventory of those items for ultimate disposal Reviews each record of therapeutic administration Develops and maintains basis for release of patients after treatment Nuclear medicine nurse Checks electronic medical record on day before treatment to ensure medication orders have been entered correctly and sends them to pharmacy on treatment day Workflow and radiation safety, including patient care and waste disposal Places intravenous catheter in patient (can also be done by nuclear medicine technologist) Medication management and Alaris pump Administers antiemetics, amino acids, and long-acting somatostatin analog Monitors for adverse events during amino acid infusion, checks blood pressure and pulse just before and after 177Lu-DOTATATE infusion, and ensures that patient voids before and hourly after infusion Nuclear medicine physician Gets informed consent from patients and reviews radiation safety instructions with patient Workflow and radiation safety Assays 177Lu-DOTATATE dose in dose calibrator, assesses intravenous line patency, performs time-out before infusion, and gives infusion Graseby pump Assesses status and discharges patient from nuclear medicine department Nuclear medicine technologist Orders, receives, inspects, and prepares 177Lu-DOTATATE dose for administration; prepares patient for treatment (can also be done by nurse) Workflow and radiation safety, including dose preparation and waste disposal Surveys restroom floor and path to treatment area with Geiger counter; contacts radiation safety officer and restricts access to contaminated areas if found Graseby pump and 177Lu-DOTATATE dose preparation Prints patient dose administration card; measures exposure 1 m from patient, and confirms that level is below that established by radiation safety officer once all administrations are complete Supply Purpose A designated treatment room and restroom To prevent radiation exposure to other people Plastic-backed kraft paper and masking tape To line walls and floor of treatment room and bathroom Scrubs for patient; scrubs, lab coat, impermeable gloves, wrist gaiters, goggles or face shield, personal dosimetry badge, and radiation detection device for technologist To monitor radiation exposure and provide personal protection Hot lab with L-block shield within biosafety cabinet To prevent radiation exposure when preparing dose Large waste bucket for sharps To collect used sharps and any waste that might contain 177Lu Workstation To document medication administration and vital signs 250-mL saline bag with extension tubing To flush dose syringe 3-way stopcock To connect dose tubing and saline tubing 22- to 20-gauge intravenous catheter system, tourniquet, chlorohexidine, Tegaderm (3M), and CoFlex adhesive bandage To establish intravenous line Microbore extension tubing To attach dose syringe to intravenous line 10-mL prefilled saline syringe To flush and check patency of intravenous line 30-mL vial of saline To train staff through simulations 1-mL syringe, 20-gauge needle To vent dose vial Gauze To raise vial inside shielded pig and to clean area Chux pads To clean and protect area Tongs, tweezers, and alcohol wipes To pick up and clean vial 30-mL lead-lined acrylic syringe shield To prevent radiation exposure when dose is drawn Wedge To tilt vial when dose is drawn 30-mL syringe; 20-gauge spinal needle 2.5–3.5 in (6.3–8.9 cm) long To draw dose Pump and tubing To infuse dose, as well as antiemetics and amino acids Tech initials Step Protect cart with chux pads Hang 250-mL saline bag; prime tubing with saline Connect tubing to 3-way stopcock; prime 3-way stopcock with saline Prime microbore tubing with saline; connect microbore tubing to 3-way stopcock Load tubing into Graseby pump Set rate on Graseby pump (50 mL/h); clear volume; change dose calibrator setting, sleeve, and plunger to those for 177Lu Label syringe with patient’s name, date of birth, medical record number, drug, dose, and date Assay vial (place gauze in bottom of pig while vial is still in dose calibrator), and record result and time; if less than 6.66 GBq or 180 mCi (7.4 GBq or 200 mCi − 10%), contact nuclear medicine physician before proceeding Draw entire dose from vial into 30-mL syringe Vent dose vial by attaching 20-gauge needle to 1-mL syringe (plunger removed) and inserting at tilted angle just enough to puncture vial Draw dose by attaching 3.5-in (8.9-cm) spinal needle to 30-mL shielded syringe, inserting into vial (tilted on wedge) until reaching its bottom, and slowly withdrawing entire volume; if withdrawal is difficult, slightly loosen thumbscrew of shield (2.5-in [6.3-cm] needle can be used but will not reach bottom) Before removing syringe, use tongs to raise vial and assess whether entire volume has been withdrawn Slowly pull syringe straight up and out of vial Pull back plunger to ensure that no liquid remains in hub of needle Discard spinal needle into sharps waste bucket; attach regular needle Remove air from syringe Assay residual activity in vial, and record result and time Assay syringe dose, and record result and time (nuclear medicine physician to confirm) Connect syringe dose to 3-way stopcock and load into Graseby pump After infusion, assay residual activity in syringe and needle
Jump to section
- Article
- Abstract
- 177LU-DOTATATE PRRT IN BRIEF
- ROLES OF MULTIDISCIPLINARY TEAM MEMBERS
- ORDERING AND RECEIPT OF 177LU-DOTATATE DOSE
- PREPARATION OF TREATMENT ROOM AND RESTROOM
- INFUSION OF AMINO ACIDS
- PREPARATION OF 177LU-DOTATATE DOSE
- INFUSION OF 177LU-DOTATATE
- FURTHER RECOMMENDATIONS
- CONCLUSION
- DISCLOSURE
- Acknowledgments
- Footnotes
- REFERENCES
- Figures & Data
- Info & Metrics