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24 May 2012

Answer to Question #421 Submitted to "Ask the Experts"

Category: Medical and Dental Patient Issues — Therapy - Radiation Oncology

The following question was answered by an expert in the appropriate field:

Hi, I am doing an assignment on brachytherapy, and I was looking for information about the precautions nurses need to take when nursing patients with a radioactive source.

Thanks.

Institutions performing temporary brachytherapy implants, where the patient is hospitalized and the sources will be removed with a day or two, are required to follow Nuclear Regulatory Commission (NRC) regulations 10 CFR Part 35. In these regulations, specifically §35.410 and §35.415, the NRC indicates what instruction must be given to nursing staff and what precautions must be taken when giving care for brachytherapy patients. I've excerpted some of this information below:

§35.410 The licensee shall provide radiation safety instruction to all personnel caring for the patient or the human research subject undergoing implant therapy. To satisfy this requirement, the instruction must describe:

Size and appearance of the brachytherapy sources;
Safe handling and shielding instructions in case of a dislodged source;
Procedures for patient or human research subject control;
Procedures for visitor control; and
Procedures for notification of the Radiation Safety Officer if the patient or the human research subject dies or has a medical emergency.

§35.415 For each patient or human research subject receiving implant therapy, a licensee shall:

Not quarter the patient or the human research subject in the same room as an individual who is not receiving radiation therapy.
Post the patient's or human research subject's door with a "Radioactive Materials" sign and note on the door or in the patient's or human research subject's chart where and how long visitors may stay in the patient's or human research subject's room;
Authorize visits by individuals under age 18 only on a case-by-case basis with the approval of the authorized user after consultation with the Radiation Safety Officer; and
Promptly after implanting the material, survey the dose rates in contiguous restricted and unrestricted areas with a radiation measurement survey instrument to demonstrate compliance with the requirements of Part 20 of this chapter.

In addition to 35.410(2), it is very important to make sure nursing staff understand who to contact in an emergency, e.g., the sources becoming dislodged. And finally, although it goes against everything nurses learned in nursing school, they need to minimize their contact time with the patient. It is encouraged that they talk to the patient from a greater distance or, perhaps, leave the lesser-priority communication items until the implant is removed. A personal suggestion would be to review information in the literature where sources have become dislodged and discuss with them the appropriate/inappropriate actions by nursing staff as well as regulatory implications.

Kelly Classic
Certified Medical Health Physicist

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