R35-1

Written: 8/93 Nursing Policy: R-35 Revised: 7/95; 6/98, 1/01; 7/04; 11/05; 9/08 LSUHSC-Shreveport, LA

RADIATION ONCOLOGY PRECAUTIONS PURPOSE To provide instructions for nursing personnel in the safe care and management of patients receiving radiation oncology treatments utilizing therapeutic Radio- active Iodine – 131 isotope; Radioactive Cesium-137 Implant, Therapeutic Gold - 198 and Iodine 125 implant; Radioactive Iridium - 192 Implant; and Therapeutic Phosphorus 32 isotope. Palladium-103 (If used must be ordered & placed on hospital radioactive license) CONTENTS

DEPARTMENT PHONE NUMBERS Nuclear Medicine Physician 56243 Radiation Physicist 54656,55328, or 58910 Radiation Oncologist 58910, 55334, or 55331 1. After Hours

After hours contact the hospital operator for Radiation Oncologist or Nuclear Medicine physician on call.

2. Reducing Exposure Note: Radiation Oncology staff will place a lead shield at the foot of the bed of each patient receiving radiation oncology implants to reduce exposure to adjacent room (s).

3. Emergency Procedures for Treatment Emergency procedures for each radiation oncology or nuclear medicine treatment are listed on the last page of instructions for that treatment.

4. Emergencies After Hours, Weekends, and Holidays For emergencies that occur after hours, weekends, and holidays, the Hospital Switchboard shall be contacted for the appropriate person on call.

Radiation Number Procedure Therapeutic Radioactive Iodine 131 isotope R35-2 Nuclear Medicine Radioactive Cesium-137 Implant for vagina, cervix, or uterus.

R35-2 Radiation Oncology

Therapeutic Gold – 198, Iodine 125, or Pd-103 implant R35-5 Radiation Oncology Radioactive Iridium – 192 Implant R35-8 Radiation Oncology Therapeutic Radioactive Phosphorus – 32 R34-10 Nuclear Medicine

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5. Nursing Staff Education Nursing staff who participate in these procedures shall receive annual training which may include inservices, completion of modules in the CPR Lab and ongoing education.

I. CARE OF PATIENTS WITH THERAPEUTIC AMOUNT OF RADIOACTIVE IODINE – 131 (Nuclear Medicine Procedure)

Iodine-131 is a mixed beta-gamma emitter and the patient receiving treatment with I-131 may cause an external radiation hazard to the personnel involved in the management of such patients. In addition, the spillage of urine, excessive perspiration, vomit, etc., may cause contamination of the bed linen or the floor.

For safe handling of such patients, the following procedures shall be implemented: A. Room Assignment

Assign an appropriate room for the patient receiving therapeutic radioisotope doses. Any private room with a toilet is acceptable.

B. Before administering the I-131 doses: 1.

2. 3.

Cover the floor, toilet, etc., with plastic-backed absorbent paper. Cover the mattress with a plastic cover and the bed with two disposable blue pads. Provide the patient with a hospital gown, pajamas, and disposable items. These shall be used to avoid possible contamination.

C. Hampers Provide two hamper stands in the room. Cover the linen bag with double plastic bags. One hamper shall be used for linens and the other for the disposable utensils, etc. These shall be kept in the patient’s room until declared contamination free by the radiation physicist or by the nuclear medicine physician in charge.

D. Posting Exposure Information Soon after the radionuclide has been administered, monitor exposure rate. This shall be done by the Radiation Physicist or by the Nuclear Medicine physician in charge. The name of the person performing the survey and the time of the survey shall be recorded. The person performing the monitoring shall post the following:

1. 2.

A “Radioactivity Precautions” tag on the door, which shall specify the name and amount of the radionuclide used, the exposure rate, any special nursing instructions and/or limitations on visitors. A similar “Radioactivity Precautions” tag shall be placed on the patient’s chart.

NOTE: NURSING PERSONNEL SHALL ENFORCE RESTRICTIONS POSTED ON THE DOOR.

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E. Monitoring Exposure in Adjacent Room The exposure rate in the adjacent room shall also be monitored. If the exposure rate is more than 2mR/hour anywhere in the room, the nurse in charge shall be notified and this room shall not be used by another patient until notified by the Radiation Physicist or by the Nuclear Medicine Physician in charge.

F. Frequency of Monitoring During the treatment, the patient’s room shall be monitored twice a day (once in the morning and once in the afternoon), and the result posted on the door.

G. Diet and Isolation Tray When diet is keyed into the computer, an isolation tray shall be ordered. All food trays and eating utensils must be disposed of in the patient’s room.

H. Minimizing Exposure for Staff Adequate patient care shall be performed quickly, but should be done cheerfully and with consideration. If the patient’s clinical status requires constant observation, rotate personnel required to perform adequate care in order to minimize exposure to personnel.

I. Linens, Dressings, and Contamination When changing bed linens, dressings, etc., or whenever contamination is suspected, never touch these items with your bare hands. Gloves shall be used and shall be discarded in the designated hamper following each use. After removal of the gloves, the hands shall be immediately washed thoroughly, with particular attention being given to the fingernails.

J. Pregnant Employees Pregnant employees shall not be assigned to the personal care of these patients.

K. Fluid Intake and Toilet Flushing The patient shall be encouraged to drink fluids to ensure frequent bladder voiding. The toilet must be flushed at least three times after each use.

L. Sharing Rooms No patient shall share the room, except for a patient who is also receiving I-131.

M. Room Confinement The patient shall be confined to the room.

N. Visitors Restricted Children (less than 18 years old) and pregnant visitors shall be restricted from the room.

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O. Discharge Instructions, Medications, and Follow-up 1.

2. 3.

These patients shall be released from the hospital in accordance with the recommendation of NCRP 37, Section 4.1.2. The Nuclear Medicine physician or the Radiation Physicist shall give appropriate instructions to the patient and to the responsible family member at the time of discharge. The attending physician shall give the patient medication and follow-up instructions.

P. Room Cleaning

1. 2. 3. 4.

After the patient is discharged, the room shall be cleaned and cleared for use by the Nuclear Medicine Department. All “Radioactivity Precaution” tags shall be removed and filed in the Radiation Physicist’s office. In case contamination is found, the Nuclear Medicine Technologist shall be responsible for the decontamination of the area. When the room is cleaned by the Nuclear Medicine Technologist, he/she shall then notify the Radiation Safety Office to collect the bagged contaminated material. After the bagged contaminated material is removed, the Nuclear Medicine Technologist shall notify Environmental Services so that the room can be cleaned for the next patient.

Q. Contacting the Administering Physician If in doubt as to the care of the patient, the administering physician shall be contacted.

R. Patient Expires If the patient expires, the administering physician shall be notified. The body must not be sent to the morgue until instructed to do so by the administering physician.

EMERGENCY PROCEDURES If spill is suspected: 1.

2.

Cover the spill area with two disposable pads to prevent the spread of the contamination. Leave the area and immediately call the nuclear medicine physician in charge and the Nuclear Medicine Technologist.

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II. CARE OF PATIENTS WITH RADIOACTIVE CESIUM-137 IMPLANT FOR VAGINA, CERVIX, OR UTERUS (Radiation Oncology Procedure)

Cesium-137 (Cs-137) sources used in radiation therapy are sealed sources, each about 2 cm long and 2 mm in diameter. This is a gamma emitter, and the patient receiving treatment with radioactive Cs-137 may cause an external radiation hazard to the nursing personnel. The following steps should be taken for the safe handling of such patients:

A. Lead Shields Two portable lead shields shall be placed by the bedside of each patient. One shield shall be placed by the side of the bed near the implant area and the other shield near the end of the bed. These shields shall be placed in the room before the sources are administered in the patient.

B. Patient and Room Monitoring After insertion of Cs-137 sources, the patient and the room shall be monitored by the Radiation Physicist, the Radiation Oncology Therapist, or the Radiation Oncologist in charge. The name of the person performing the survey and the time of the survey shall be recorded. The exposure rate at a distance of one meter from the appropriate center of the implant shall be entered in the patient’s chart and on the tag. The following tags shall be posted:

1. 2. 3.

A “Radioactivity Precautions” tag shall be posted on the door, which specifies the name and activity of the radionuclide used, the exposure rate at one meter, and the time of measurement. A separate tag shall be posted specifying the time limitations of the nurses and of the visitors. A “Radioactivity Precautions” tag shall be attached to the patient’s chart.

NOTE: NURSING PERSONNEL SHALL ENFORCE THE RESTRICTIONS POSTED ON THE DOOR.

C. Monitoring Exposure in Adjacent Room

The exposure rate in the adjacent room shall also be monitored before and after the Cs-137 implant is place. If the exposure rate is more than 2mR/hour anywhere in the adjacent room, the nurse in charge shall be notified and this room shall not be used by any other patient until the treatment termination of the Cs-137 implant.

D. Pregnant Employees Pregnant employees shall not be assigned to care for these patients.

E. Children and Pregnant Visitors Children (less than 18 years old) and pregnant visitors shall be restricted from the room.

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F. Sharing Rooms No other patient shall share the room, except a patient who is also receiving Cesium-137, Iridium-192, Gold-198, or I-125 sealed source implant.

G. Visitors Visitors shall check with the nurse before entering the room and shall stand behind the lead shield, not exceeding the time posted on the door.

H. Employee Exposure The nurses attending the patient shall not stay in the room any longer than the time posted on the door. They, also, shall stand behind the lead shield as much as possible.

I. Badges All employees shall wear their film badges, obtained from the Radiation Safety Office, when entering the room.

J. Proper Patient Care For proper Radiation Oncology patient care, the physician’s orders shall be followed.

K. Checking Patient It shall be the responsibility of the Radiation Oncologist to assure that the patient is stable, the application is secure, and check the patient for profuse bleeding. The RN/RN Applicant should notify the Radiation Oncologist if any signs of the preceding are observed.

L. Removal of Sources After the delivery of the prescription dose, the sources shall be removed from the patient by the Radiation Oncologist and shall be brought back to the Radiation Oncology Department. Room Survey The room shall be again surveyed by the Radiation Physicist, the Radiation Oncology Therapist, or the Radiation Oncologist in charge, and the result entered in the patient’s chart. All “Radioactivity Precautions” tags shall be removed and filed in the Radiation Oncology Department.

NOTE: AFTER THE SOURCES ARE REMOVED, THE PATIENT IS NO LONGER RADIOACTIVE.

M. Questions about Patient Care If in doubt as to any procedure concerning the care of the patient with Cs-137 Implant, the Radiation Oncologist shall be contacted

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N. Patient Death If the patient expires during the treatment, the Radiation Oncologist in charge shall be notified. The body shall not be removed until instructed to do so by the Radiation Oncology physician in charge and all radioactive material has been removed.

EMERGENCY PROCEDURES If part of the packing or the applicator and/or source accidentally comes out, the following steps shall be taken immediately: A.

B. C. D. E. F.

If dislodged source or instruments are found, floor nursing staff should place the vaginal packing, applicator and/or source in the lead-shielded cart, which is left in the room by the Radiation Oncology personnel. Handle sources using 30 centimeter long forceps with minimal pressure. Forceps are located on lead shielded cart. Keep sources extended away from the body at arm’s length. Place source in lead-lined cart and move cart to the patient’s bathroom. Document time and location of where source was found. Contact the Radiation Oncologist and the Radiation Oncologist will contact the Physicist. Document notification in the Nurses Notes.

NOTE: NEVER TOUCH A SOURCE WITH BARE HANDS. USE GLOVES AND FORCEPTS WHEN HANDLING THE SOURCE

If the accident mentioned above occurs during office hours, the Radiation Oncologist in charge and the Radiation Physicist shall be notified immediately. If the accident mentioned above occurs after office hours, the Radiation Oncologist in charge shall be called. Contact hospital operator for Radiation Oncologist on call. Remove the transport cart with the source inside to the Radiation Oncology Department and place the cart in the Radiation Storage Room (130 in the Radiation Therapy Center). Call University Police to unlock the storage room. Record in the patient’s chart the time the sources or applicators were discovered out of the patient.

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IF A SOURCE LOSS IS SUSPECTED DURING THE ACCIDENT MENTIONED ABOVE: A.

B. C. D. E.

Call the Radiation Oncologist in charge and the Radiation Physicist immediately.

Leave the patient in room with minimal attendance. Do not allow any visitors to enter the patient’s room. Do not remove any items from the patient’s room. Do not move anything in the patient’s room.

III. CARE OF PATIENTS WHO HAVE RECEIVED THERAPEUTIC AMOUNT OF

GOLD-198 OR IODINE-125 FOR PERMANENT IMPLANT (Radiation Oncology Procedure)

Radioactive Gold-198 (Au-198) and Iodine-125 (I-125) sources are used in the form of encapsulated seeds (about 1 mm in diameter, 4 mm long). They are gamma emitters, and the patient receiving treatment with Au-198 or I-125 may cause an external radiation hazard to the personnel involved in the management of such patients. The following steps shall be taken for the safe handling of such patients:

A. For Procedures Done In The Operating Room: 1.

2.

Sterilization of Seeds Au-198 or I-125 seeds shall be sterilized in the Operating Room sterilizer 30 minutes before the procedure is scheduled in the OR. The seeds are arranged in the cartridge and place din a lead container by the Radiation Oncology nurse before being handed over to the Operating Room nurses for sterilization. Sterilization of Lead Container The Operating Room nurse in charge of the sterilizer shall sterilize the seeds along with the lead container, leaving the caps open and flashing it for 10-25 minutes. The lead cap shall be sterilized at the same time. The container shall be covered as soon as it is removed from the sterilizer, and brought to the Operating Room maintaining sterility.

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3. Permanent Prostate Seed Implant Brachytherapy is a low energy type of radiation which small radioactive sources are permanently implanted inside the tumor. a. Patients are to undergo bloodwork and other preoperative studies before the day of the implant in order to be approved by anesthesia. b. Morning of the procedure: patients may receive an enema to clean out the lower part of the bowel. c. Patient receives general or spinal anesthesia. d. Sterilized Mick Applicator is used for seed delivery. Applicator is designed for implant of I-125 or Pd-103 seeds. Preloaded needle cartridge is inserted into applicator for insertion of seeds. (Needles come preloaded, and sterilized by the vendor.. They can be individually (free seeds) or as part of a connected strand of seeds.) e. Transrectal Ultrasound is inserted through the stepper into the rectum. f. Needles are inserted first without the presence of seeds to avoid radiation exposure to hands and fingers. This procedure is done by Urologist and Radiation Oncologist. g. Verification of seed placement is required. All seeds must be accounted for. h. Patient is then transferred to the recovery room.

NOTE: SEEDS SHALL REMAIN IN THE LEAD CONTAINER AT ALL THE TIMES UNTIL PLACED IN THE PATIENT.

4. 5. 6. 7.

Placement of Seeds These seeds shall be placed in the patient by the Radiation Oncologist in the Operating Room. Patient Monitoring The Radiation Physicist or the Radiation Oncologist in charge shall monitor the patient and shall be accountable for all seeds. The name of the person performing the survey and the time of survey shall be recorded. Patient Location After this procedure, the patient is radioactive and shall be assigned a bed in PACU, as far away from other patients as possible. Placement of Lead Shields A portable lead shield shall be placed by the side of the patient near the implant area. This shall be ordered by the Radiation Oncologist, as needed.

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8. Personnel and Children Protection Personnel taking care of the patient shall remain behind the lead shield as much as possible. Pregnant employees shall not be assigned to care for these patients (Children less than 18 years old) shall not enter the room.

B. For Management of Patient on the Unit: 1. Posting Tags

After recovery, the patient shall be transported through the hospital. If the elevators being used, do not transport patients with visitors, ask all persons to vacate the elevator being used. Once the patient is brought to the room on the nursing unit, the patient and room shall be monitored by the Radiation Physicist or by the Radiation Oncologist in charge. The exposure rate at a distance of 1 meter from the appropriate center of the implant is entered in the patient’s chart and on the tag. The following tags shall be posted: Radioactive Precautions Tag (Door) A “Radioactivity Precautions” tag shall be posted on the door, which specifies the name and activity of the radionuclide used, the exposure rate at one meter, and the time of measurement.

Visitor Limitation Tag A separate tag shall be posted specifying the time limitations of the nurses and of the visitors. Radio Precautions Tag (Chart) A “Radioactivity Precautions” tag shall also be attached to the patients chart.

NOTE: NURSING PERSONNEL SHALL ENFORCE THE RESTRICTIONS POSTED ON THE DOOR.

2. 3. 4.

Lead Shield Placement A portable lead shield shall be placed by the side of the bed near the implant area.

Patient Confinement The patient shall be confined to his room until ordered otherwise, but may be out of bed. Monitoring Exposure in Adjacent Room The exposure rate in the adjacent room shall also be monitored. If the exposure rate is more than 2 mR/hour anywhere in the adjacent room, the nurse in charge shall be notified and the room shall not be used by any other patient until cleared by the Radiation Physicist, the Radiation Oncology Therapist, or the Radiation Oncologist in charge.

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5. 6. 7. 8. 9. 10. 11. 12. 13.

X-rays Two portable x-ray films shall be taken (one AP and one lateral) with a magnification ring properly placed. For magnification ring and placement, contact the Radiation Physicist, Radiation Oncology Therapist, or Radiation Oncologist. Children and Pregnant Visitors Children (less than 18 years old) and pregnant visitors shall be restricted from the room. Room Sharing No patient shall share the room, except a patient who is also receiving Cesium-137, Iridium-192, Gold-198, or I-125 implant. Visitors Visitors shall check with the nurse before entering the room and shall stand behind the lead shield, not exceeding the time posted on the door. Employee Exposure Nursing staff attending the patient shall not stay in the room any longer than the time posted on the door and shall remain behind the lead shield, as much as possible. Badges All employees shall wear their film badges, obtained from Radiation Safety, when entering the room. Checking Implant Site The implant site shall be checked for bleeding. If active bleeding is observed, the Radiation Oncologist shall be called immediately. Questions About Patient Care If in doubt of any procedure concerning the care of a patient with Au-198 or I-125, the Radiation Oncologist in charge shall be contacted. Patient Release These patients shall be released from the hospital when the amount of radiation is low, in accordance with NCRP 37, Section 4.1.2. Appropriate instructions shall be given to the patient and to the responsible family member at the time of discharge by the Radiation Oncologist in charge or by the Radiation Physicist.

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14. 15.

Room Cleanup After the patient is discharged, the room shall be surveyed by the Radiation Physicist. In the absence of the physicist, the Radiation Oncologist or department designee shall perform this function. All Radioactivity Precaution tags shall be removed and filed in the Radiation Physicist’s office. If contamination is found, the physicist shall be responsible for the decontamination of the area and locating the dislodged source. After the source is located and the room is free of contaminates, the physicist shall instruct the nurses that the room is released for cleaning and use. Patient Death If the patient expires, the Radiation Oncologist in charge shall be called. The patient must not be sent to the morgue and no autopsy shall be performed until instructed to do so by the Radiation Oncologist in charge.

EMERGENCY PROCEDURES If a source is accidentally found outside of the implant, place the seed in the lead-shielded cart, which is left in the room by the radiation oncology nurse. A.

B. C.

Handle the source using 30 centimeter long forceps with minimal pressure. Forceps are located on the lead shielded cart. Keep source extended away from the body at arm’s length. Patient shall stay in bed until the lost source is found and secured.

NOTE: NEVER TOUCH A SOURCE WITH BARE HAND. USE FORCEPS WHEN HANDLING THE SOURCE.

If the accident mentioned above occurs during office hours, the Radiation Oncologist in charge and the Radiation Physicist shall be called immediately. If the accident mentioned above occurs outside office hours, the Radiation Oncologist in charge shall be called. Contact the hospital operator for Radiation Oncologist on call. Remove the transport cart with the source inside to the Radiation Oncology Department and place the cart in the Radiation Storage Room (room 103 in the Radiation Center). Call University Police to unlock the storage room. Record in the patient’s chart the time the sources were discovered out of the patient.

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IF A SOURCE LOSS IS SUSPECTED DURING THE ACCIDENT MENTIONED ABOVE: A.

B. C. D. E.

Call the Radiation Oncologist in charge and the Radiation Physicist immediately.

Leave the patient in room with minimal attendance. Do not allow any visitors to enter the patient’s room. Do not remove any items from the patient’s room. Do not move anything in the patient’s room.

IV. MANAGEMENT OF PATIENTS WITH RADIOACTIVE IRIDIUM-192 IMPLANT TEMPORARY IMPLANTS (Radiation Oncology Procedure)

A. B. C. D.

External Radiation Hazard Iridium-192 (Ir-192) is a gamma-emitting isotope, and the patient receiving treatment with IR-192 may cause an external radiation hazard to the personnel involved in the management of such patients. The following information will provide the necessary steps to be taken for safe handling of such patients.

Source Description Ir-192 isotope is a sealed radioactive source and is used in the form of seeds (looks like a small piece of metallic wire about 1 mm in diameter and 4 mm long) arranged 1 cm apart in a tightly fitting nylon ribbon. The number of such ribbons and total activity used in each patient depends on the prescription dose. Insertion This is an after loading technique. The implant tubes are inserted in the tumor in OR and the patient is then transferred to his/her room. The sources are inserted in the implant tubes in the room by the Radiation Oncologist. Lead Shields A portable lead shield shall be placed near the bedside near the treatment implant area prior to the administration of the radioactive sources. After administration of IR-192 sources, the patient is radioactive and the room shall be monitored by the Radiation Physicist or by the Radiation Oncologist in charge. The name of the person performing the survey and the time of the survey shall be recorded. The exposure rate at a distance of one meter from the appropriate center of the implant shall be entered in the patient’s chart and on the tags.

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Posting Tags The following tags shall be posted: Radioactivity Precaution Tag (Door) A “Radioactivity Precaution” tag shall be posted on the door and shall specify the name and activity of the radionuclide used, the exposure rate at one meter, and the time of measurement. Time Limitation Tag A separate tag shall be posted specifying the time limitation of the nurses and of the visitors. Radioactivity Precaution Tag (Chart) A “Radioactivity Precaution” tag shall also be attached to the patient’s chart.

NOTE: NURSING PERSONNEL SHALL ENFORCE THE RESTRICTIONS POSTED ON THE DOOR.

E. F. G. H. I. J.

Monitoring Exposure in Adjacent Room The exposure rate in the adjacent room shall also be monitored. If the exposure rate is more than 2 mR/hour anywhere in the adjacent room, the nurse in charge shall be notified and this room shall not be used by any other patient until the treatment of the IR-192 implant is terminated.

Pregnant Employees Pregnant nurses and/or pregnant employees shall not be assigned to the personal care of these patients. Children and Pregnant Visitors Children (less than 18 years old) and pregnant visitors shall be restricted form the room. Sharing Rooms No patient shall share the room, except a patient who is receiving Cesium-137, Iridium-192, Gold-198, or I-125 implant. Visitors Visitors shall check with nurse before entering the room and shall stand behind the lead shield, not exceeding the time posted on the door. Employee Exposure The attending nurse and physician shall not stay in the room any longer than the time posted on the door. They, also stand behind the lead shield as much as possible.

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K. L. M. N. O. P.

Badges All employees shall wear their film badges, obtained from Radiation Safety, while on duty.

Checking Implant Site The implant site shall be checked for bleeding. If bleeding is observed, the Radiation Oncologist shall be called immediately. Patient Confinement The patient shall be confined to his room. Questions about Patient Care If in doubt of any procedure concerning the care of a patient with an Ir-192 implant, the Radiation Oncologist in charge shall be contacted. Source Removal After the delivery of the prescription dose, the sources shall be removed from the patient by the Radiation Oncologist. The room shall be surveyed again by the Radiation Physicist, the Radiation Oncology Therapist, or the Radiation Oncologist in charge, and the result entered in the patient’s chart. All “Radioactive Precaution” tags shall be removed and filed in the Radiation Oncology Department.

NOTE: After the sources are removed, the patient is no longer radioactive.

Patient Death If the patient expires during the treatment, the administering physician shall be called. The body shall not be removed until instructed to do so by the administering physician and radioactive material has been removed.

EMERGENCY PROCEDURES If a source is accidentally found outside of the implant, place the source in the lead-shielded cart, which is left in the room by the radiation oncology nurse. A.

B.

Handle the source using 30 centimeter long forceps with minimal pressure. Forceps are located on the lead-shielded cart.

Keep source extended away from the body at arm’s length.

NOTE: NEVER TOUCH A SOURCE WITH BARE HANDS. If the accident mentioned above occurs during office hours, the Radiation Oncologist in charge and the Radiation Physicist shall be notified immediately.

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If the accident mentioned above occurs after office hours, the Radiation Oncologist in charge shall be notified. Contact the hospital operator for the Radiation Oncologist on call. Remove the transport cart with the source inside to the Radiation Oncology Department and place the cart in the Radiation Storage Room (room 130 in the Radiation Center). Call University Police to unlock the storage room. Record in the patient’s chart the time the sources or applicators were discovered out of the patient. IF A SOURCE LOSS IS SUSPECTED DURING THE ACCIDENT MENTIONED ABOVE: A.

B. C. D. E.

Call the Radiation Oncologist in charge and the Radiation Physicist immediately.

Leave the patient in room with minimal attendance. Do not allow any visitors to enter the patient’s room. Do not remove any items from the patient’s room. Do not move anything in the patient’s room.

V. CARE OF THE PATIENTS WITH THERAPEUTIC RADIOACTIVE PHOSPHORUS-32 (P-32) (Nuclear Medicine Procedure)

Drug Overview Phosphorus-32 (P-32) is a pure beta emitter, and patients receiving treatment with radioactive P-32 colloidal solution exhibit no significant external radiation hazard to the nursing personnel. No special shielding is necessary. Hazard The primary hazard from this procedure is the leakage from the puncture wound, made during the injection of the radioactive material, which might cause contamination.

Safe Handling of Patients The following steps shall be taken for the safe handling of such patients:

A. B.

Hospital Gown The patient shall wear a hospital gown prior to instillation of P-32 to avoid possible contamination and shall be provided other disposable items as needed. Bed Coverings The patient’s bed shall be covered with two disposable pads.

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C. D. E.

Wastebasket A wastebasket shall be designated for the collection of contaminated materials. Two plastic bags shall be obtained from Environmental Services to cover this waste basket. During the treatment, contaminated gauze, syringes, tubing, etc., shall be collected in this basket. These shall be kept in the patient’s room until declared contamination free by the Radiation Physicist or by the Nuclear Medicine physician in charge. Handling Contaminated Linen Whenever contamination is suspected, never touch with bare hands. Always use surgical or rubber gloves. The rubber gloves shall be washed thoroughly before removing from the hands. After removal of the gloves, the hands shall be immediately washed thoroughly with particular attention being given to the fingernails. Monitoring Exposure Rate Soon after the radionuclide has been administered, the exposure rate shall be monitored by the Radiation Physicist or by the Nuclear Medicine physician in charge. The person performing the survey shall record his name and the time of the survey and shall post the following tags:

1. 2.

A “Radioactivity Precautions” tag on the door, which shall specify the name and amount of the radionuclide used, the exposure rate, any special nursing instructions and/or limitations on visitors. A similar “Radioactivity Precautions” tag shall also be placed on the patient’s chart.

NOTE: Nursing personnel shall enforce the restrictions posted on the door.

F. Checking for Leakage As mentioned before, the primary concern is the leakage from the puncture wound. The dressing over the operative site shall be inspected visually several times each day. If there is evidence of drainage, the Nuclear Medicine physician in charge shall be notified immediately. Do not change these dressings without the physician’s approval. Again, always use rubber gloves or tongs to handle these dressings and discard all of these dressings in the designated radioactive wastebasket.

G. Discarding Excreta All excreta shall be discarded into the toilet.

1.

Intravenous P-32: a. If the patient can use the toilet, he may do so in the usual manner, but the toilet shall be flushed three times after use. b. If the patient cannot use the toilet, the bedpan shall be rinsed thoroughly after each use – at least three times.

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2.

c. Spillage of urine, vomitus or sputum may cause contamination. In case of spillage, the spill areas shall be covered with two disposable blue pads to prevent contamination. The Nuclear Medicine physician in charge and the Radiation physicist shall be notified of any spillage. Intraperitoneal P-32: None of these special precautions are necessary.

H. I. J. K. L. M. N.

Sharing Rooms No patient shall share the room, except a patient who is also receiving P-32.

Pregnant Employees Pregnant employees shall not be assigned to the personal care of these patients. Children and Pregnant Visitors Children (less than 18 years old) or pregnant visitors shall be restricted from the room. Patient Confinement The patient shall be confined to the room. Room Cleanup After the patient is discharged, the room shall be surveyed by the Radiation Physicist. In the absence of the physicist, the Nuclear Medicine Department shall perform this function. All “Radioactivity Precaution@ tags shall be removed and filed in the Radiation Physicist office. In case contamination is found, the physicist shall be responsible for the decontamination of the area. When the room is cleaned by the physicist, he/she shall then notify the Radiation Safety Office to collect the bagged contaminated material. After the bagged contaminated material is removed, the physicist shall notify housekeeping so that the room can be cleaned for the next patient.

Questions about Patient Care If in doubt as to the care of the patient, the administering physician shall be contacted. Patient Death If the patient expires, the administering physician shall be called and the body must not be sent to the morgue until instructed to do so by the administering physician.

EMERGENCY PROCEDURES

If spill is suspected, cover the spill area with two disposable pads to prevent spread of contamination. Leave the area and immediately call the Nuclear Medicine Physician in charge and the Radiation Physicist.

R-35: Radiation Oncology Precautions Page 19 of 19

R35-19

__________________ Jamie Jett, MBA, RN Date Director, Patient Care Support/Medicine Services Jean DiGrazia, MBA, RN Date Assistant Administrator and CNO Patient Care Services