All ONS Member Community

Expand all | Collapse all

Lutathera

  • 1.  Lutathera

    Posted 01-22-2019 08:43

    Good Morning!  Is anyone administering Lutathera – radionuclide Therapy – in an area in their Infusion Center?   It is indicated for gastric neuroendocrine tumors.  We are presently working with radiation safety and may be administering this in our unit.

     

    Thank you

    Eileen

     

    Eileen Dwyer,BSN,RN,OCN

    Nurse Manager, Infusion Center

    St Francis Hospital

    Phone: (516) 325-7516

    Ascom: (516) 325-7545

    Fax: (516) 325-7531

    Email: eileen.dwyer@chsli.org

     

    The information in this e-mail, and any attachments therein, is confidential and for use by the intended addressee only. If this message is received by you in error please do not disseminate or read further. Please reply to the sender that you have received the message in error, then delete the message. Although Catholic Health Services of Long Island attempts to sweep e-mail and attachments for viruses, it does not guarantee that either are virus-free and accepts no liability for any damage sustained as a result of viruses. Thank you.


  • 2.  RE: Lutathera

    Posted 01-23-2019 09:42
    Edited by Chelsea Backler 01-23-2019 09:42
    Hi Eileen,

    If it is helpful, the Voice recently published a drug reference sheet on Lutathera which contains key points surrounding adverse effects, administration, and patient education. You can find it in the January print copy of the Voice or online here: https://voice.ons.org/news-and-views/oncology-drug-reference-sheet-lutetium-lu-177-dotatate?utm_campaign=Voice_Newsletter_Member&utm_content=template_id&utm_medium=email&utm_source=email

    ------------------------------
    Chelsea Backler, MSN, APRN, AGCNS-BC, AOCNS
    Oncology Clinical Specialist
    Oncology Nursing Society
    www.ons.org
    ------------------------------



  • 3.  RE: Lutathera

    Posted 01-23-2019 10:34

    Thank you for that reference!

     

    Eileen

     

    Eileen Dwyer,BSN,RN,OCN

    Nurse Manager, Infusion Center

    St Francis Hospital

    Phone: (516) 325-7516

    Ascom: (516) 325-7545

    Fax: (516) 325-7531

    Email: eileen.dwyer@chsli.org

     

    The information in this e-mail, and any attachments therein, is confidential and for use by the intended addressee only. If this message is received by you in error please do not disseminate or read further. Please reply to the sender that you have received the message in error, then delete the message. Although Catholic Health Services of Long Island attempts to sweep e-mail and attachments for viruses, it does not guarantee that either are virus-free and accepts no liability for any damage sustained as a result of viruses. Thank you.





  • 4.  RE: Lutathera

    Posted 01-23-2019 10:33
    ​Yes,, we're administering 3-4 doses/week in our infusion room.  Happy to answer any questions you may have.

    ------------------------------
    Joy Lombardi, BSN, RN, OCN
    Clinical Operations Dir.
    Huntsman Cancer Institute
    Salt Lake City, UT
    joy.lombardi@hci.utah.edu

    ------------------------------



  • 5.  RE: Lutathera

    Posted 01-23-2019 15:51
    ​Do you administer Lutathera using the 2 needle method?  Do you use a pump?  Would you be willing to share your nursing protocol?
    Kim Mona
    RN MSN AOCNS

    ------------------------------
    Kimberly Mona RN MSN
    MHP Radiation Oncology Institute
    Rochester Hills MI
    ------------------------------



  • 6.  RE: Lutathera

    Posted 01-24-2019 10:23

    Forgot to mention we do use a pump for administration.  Below is our Quick Tips information sheet.  We are also presenting a poster at Congress on our Lutathera experience.

     

    Lutathera Quick Tips

    Set-up: 

    ·         Bathroom prepped and bed 6 lined with chux; MAs to complete day before treatment

    ·         Get 2 pumps (one for Lutathera/one for the Amino Acids)

    ·         Switch trash bags to clear Nuclear Med bags

    ·         Ensure patient has 2 access points (double lumen Port); AAs must infuse through central line

    ·         Make sure patient is not incontinent of urine or stool

    Tubing:

    ·         Prime tubing with NS

    ·         Amino Acids:  Regular tubing with added 1.2 filter

    ·         Lutathera:  Regular tubing with 18 gauge needle on the end.

    o    Spinal needle connection (see picture).  Leave on chux on bedside table.

    Treatment:

    ·         Release Therapy Plan ASAP, including prn anti-emetics following patient assessment, VS, access, and consent signed.

    ·         Give Pre-meds 30 minutes before starting the AA's

    ·         At start of AA's:

    o    Notify (Nuclear Med) #7-4716

    o    Notify ordering provider

    o    Start AA's at 320ml/hour (Don't increase until the Lutathera is done!)

    ·         Lutathera comes from Nuclear Medicine and begins 30 minutes after AA's are initiated

    o    Make sure you are wearing your badge

    o    Ensure patient has urinated

    o    Family needs to leave the room until patient is discharged. Nuclear Med charts the Lutathera in Epic.

    o    Titrate Lutathera, set up pump accordingly (can pre-program):

           Begin at 50ml/hr for 10 minutes (8.4 ml volume).

           Increase to 200ml/hr for 20 minutes (67 ml volume).

           Increase to 500ml/hr for remainder (174.6 ml volume).

           The end rate is the flush.  Should be approximately 18 minutes. 

    ·         Once Lutathera is complete, increase AA's as tolerated. Patient will receive 2 L total of AAs.

    o    Decrease rate of AA's if patient nauseated and give prn anti-emetics.

    o    Nuclear Med disposes of Lutathera vial and tubing

    o    Patient can eat/drink.  Dispose of trash in clear Nuclear Med bags.

    ·         Post Lutathera:

    o    Vitals to be done as needed

    o    After patient discharged, call Radiation Safety #1-6141 to remove garbage and "clear" patient room and bathroom. Once cleared, call environmental services #7-4717.

     

     






  • 7.  RE: Lutathera

    Posted 01-24-2019 12:29

    This is great information... Thank you for sending this!

     

    Does the Radiation or Nuclear Medicine physician always administer the Lutathers themselves?

     

    Eileen

     

    Eileen Dwyer,BSN,RN,OCN

    Nurse Manager, Infusion Center

    St Francis Hospital

    Phone: (516) 325-7516

    Ascom: (516) 325-7545

    Fax: (516) 325-7531

    Email: eileen.dwyer@chsli.org

     

    The information in this e-mail, and any attachments therein, is confidential and for use by the intended addressee only. If this message is received by you in error please do not disseminate or read further. Please reply to the sender that you have received the message in error, then delete the message. Although Catholic Health Services of Long Island attempts to sweep e-mail and attachments for viruses, it does not guarantee that either are virus-free and accepts no liability for any damage sustained as a result of viruses. Thank you.





  • 8.  RE: Lutathera

    Posted 01-24-2019 13:18

    Great synopsis everyone!

     

    At our facility, only a nuc med tech or radiation safety officer (RSO) will be administering the Lutathera dose. The amino acids infusion, will be administered and monitored by nursing.

     

    Thank you,

     

    Jennifer Graham, MSN, RN, AGCNS-BC

    Clinical Nurse Specialist

    Center for Nursing Excellence

    208-381-1493

    grahamje@slhs.org

     

     


    "This message is intended for the use of the person or entity to which it is addressed and may contain information that is confidential or privileged, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this information is strictly prohibited. If you have received this message by error, please notify us immediately and destroy the related message."





  • 9.  RE: Lutathera

    Posted 01-24-2019 13:26

    Yes, the NM tech administers the Lutathera, but the nurse runs the pump for the Lutahera and handles the amino acid infusion and premeds.

    Joy Lombardi

    Huntsman Cancer Institute






  • 10.  RE: Lutathera

    Posted 01-26-2019 16:31
    At our institution the rad. onc is the one that starts the actual infusion of LU.  We are having staff wear gowns and double glove if they are going to be touching anything with drawing up or administering.  We have used both the double needle and have now moved onto using a pump.
    There seems to be more radio-pharmaceuticals coming out.  Also many clinical trials are coming out.  I am happy to see this on the Congress lecture series.

    ------------------------------
    Pamela Laszewski BSN RN
    Clinical Leader
    Karmanos Cancer Center
    Detroit MI
    ------------------------------



  • 11.  RE: Lutathera

    Posted 01-28-2019 08:42

    We do not use the 2 needle method. We see between 2-3 pts a day with this ( our numbers are tapering off now that we have reached the 4th cycle on many).  Our nuclear med techs give the Lutathera, after our Nuc Med doctor has discussed the treatment with them.  We have had to admit a few of the pts following the treatment, mostly with shortness of breath and chest pain.  Both were caused by pleural effusions and pericarditis.  It was noted that those pts also had pre-existing carcinoid heart prior to the infusions and related to their disease.

    Yes, Lutathera treatment will be in the sessions of the Radiation Track at Congress this year.

     

    Pamela Grubbs, APRN, CNS, MS, AOCNS

    Clinical Nurse Specialist, Hematology/Oncology

     

     






  • 12.  RE: Lutathera

    Posted 08-16-2019 12:21
    Can you tell me if you are able to use a port? My facility is choosing to only use PICC lines and we have a upset patient that wants the port used. Can you explain the rationale behind the choice for one over the other at your facility?

    ------------------------------
    Elizabeth Cline RN BSN
    Claremore OK
    ------------------------------



  • 13.  RE: Lutathera

    Posted 08-16-2019 12:43

    The port can't be used due to potential radiation contamination.  We have used peripheral lines or double lumen PICCs that are inserted same day and removed after the day's treatment.

     

    Joy

    Joy Lombardi, BSN, RN, OCN

    Nursing Director

    Huntsman Outpatient Infusion

    Huntsman Cancer Institute

    801-585-9822

    Joy.lombardi@hci.utah.edu

     

                  

     

    Changing the DNA of Cancer Care

     

    u_health_email

     






  • 14.  RE: Lutathera

    Posted 08-16-2019 15:47
    ​Yes, I agree with Joy. Our institution administers 2-4 doses a day ( weekdays) of Lutathera so we have had a lot of experience with this.  We consulted the company who makes Lutathera and it advised to not use a port due to the metal in the port.  We have used pts Hickmans , if they already have them, for administration but the majority of the  several hundred we have done have been through peripheral IV's.

    ------------------------------
    [Pamela] [Grubbs] [CNS]
    Clinical Nurse Specialist
    [Mayo Clinic]
    [Rochester] [Mn]
    PamelaPamelaGrubbsPamela
    ------------------------------



  • 15.  RE: Lutathera

    Posted 30 days ago
    ​When the pt is receiving the LU dose, does the nurse stay in the area with the patient or is the administration started and you check in on the pt during the infusion,  We currently have the nurse wait outside the room and we can see them and then we check on them by going in the room.  I have been asked though if it is necessary for the nurse to stay with the pt.  We do not see any NRC regulations regarding this issue.

    Thank you

    ------------------------------
    Pamela Laszewski BSN RN
    Clinical Leader
    Karmanos Cancer Center
    Detroit MI
    ------------------------------



  • 16.  RE: Lutathera

    Posted 30 days ago

    We have the nurse wait outside.  We have ICU type rooms with glass doors so we can see what's happening.  The nurse needs to go in at least twice to adjust the pump rate or for any patient needs.

    The NM tech also stays in the room or near the door.

     

    Joy

    Joy Lombardi, BSN, RN, OCN

    Nursing Director

    Huntsman Outpatient Infusion

    Huntsman Cancer Institute

    801-585-9822

    Joy.lombardi@hci.utah.edu

     

                  

     

    Changing the DNA of Cancer Care

     

    u_health_email

     






  • 17.  RE: Lutathera

    Posted 01-23-2019 10:51
    ​We are giving it here at our network, however it is all done in the radiation department at this time.

    ------------------------------
    Stephanie Bowser
    Nurse Manager ]
    ------------------------------



  • 18.  RE: Lutathera

    Posted 01-23-2019 13:04

    We are just starting this next month at our cancer center. We will be performing this in an outpatient setting that is actually located within our inpatient department. Happy to discuss how we will do this with anyone that is interested.

     

    Jennifer Graham, MSN, RN, AGCNS-BC

    Oncology Clinical Nurse Specialist

    St. Luke's Health System

    (  208-381-1493
    +  grahamje@slhs.org

     


    "This message is intended for the use of the person or entity to which it is addressed and may contain information that is confidential or privileged, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this information is strictly prohibited. If you have received this message by error, please notify us immediately and destroy the related message."





  • 19.  RE: Lutathera

    Posted 01-23-2019 15:54
    Can you share your nursing protocol?  I have some nurses who are very concerned about the radiation exposure.  What PPE are the nurses wearing?  Anything you can share would be appreciated.  We are hoping to start soon in Michigan.
    Kim Mona​

    ------------------------------
    Kimberly Mona RN MSN
    MHP Radiation Oncology Institute
    Rochester Hills MI
    ------------------------------



  • 20.  RE: Lutathera

    Posted 01-24-2019 09:07
    ​We will be doing the 2 needle method.......but right now I am concerned about radiation safety for the staff and our other patients in our infusion unit.....we will begin radiation safety staff meetings next month and educational in-services.  Hoping that this education will answer all staff questions to decrease any concerns about exposure...

    Eileen

    ------------------------------
    Eileen Dwyer RN
    Garden City NY
    ------------------------------



  • 21.  RE: Lutathera

    Posted 01-24-2019 10:08

    We also use the 2 needle method.  We have had great support from our Radiation Safety officers and there is always one of them present at each dose.  We did multiple staff meeting education sessions, given by our medical physicist, but there was still some staff who were hesitant.  We just continued to educate and it seems that everyone came around.  It has been a challenge, though, when situations arise where other staff outside of infusion need to get involved-for instance, one of our patients needed admission to ICU right after the infusion and we had just discussed including inpatient staff in education in preparation for something like that, but hadn't done it.  We had to do some "just in time" education, and our Radiation Safety staff was very helpful in educating staff as well.

    Joy Lombardi, BSN, RN, OCN

    Huntsman Cancer Institute






  • 22.  RE: Lutathera

    Posted 01-26-2019 16:23
    Can you share why this patient had to go to ICU?  Is there something you have learned that requires extra monitoring?
    Thanks for sharing.

    ------------------------------
    Pamela Laszewski BSN RN
    Clinical Leader
    Karmanos Cancer Center
    Detroit MI
    ------------------------------



  • 23.  RE: Lutathera

    Posted 01-24-2019 12:33

    We give Lutathera in the area where I support and am currently placing these pts in our radiation rooms where they have their own bathroom ( since it is excreted in urine). The stay is approximately 6 hours since there is a 4 hour infusion of amino acids, besides all the antiemetics. Can you give more information on what you have questions regarding?



    ------------------------------
    [Pamela] [Grubbs] [CNS]
    Clinical Nurse Specialist
    [Mayo Clinic]
    [Rochester] [Mn]

    ------------------------------