ANAHEIM, CALIFORNIA—Three principles can help nurses minimize radiation exposure levels when caring for patients receiving high-dose ablative therapy for thyroid cancer, according to research presented at the Oncology Nursing Society (ONS) 39th Annual Congress.
“The knowledge of radiation safety practices is essential for oncology nurses to reduce occupational injury and protect the public,” Monica Beck, RN, MSN, OCN, of the University of Alabama College of Nursing, said during a podium session.
She noted this is especially important in light of the rising incidence of thyroid cancer. With more of these patients receiving high-dose ablative therapy, such as radioactive iodine (I-131), it is likely that oncology nurses will care for a radioactive patient at some point.
Beck and colleagues conducted a literature review to provide this essential knowledge to nurses.
The principle for managing radiation exposure is As Low As Reasonably Achievable (ALARA). Achieving ALARA exposure rates involves three concepts: time, distance, and shielding. The question is how do nurses implement these concepts to minimize occupational risk?
Typically, immediately after dosing, radiation exposure 1 meter from the chest is 100 mrem per hour and drops off significantly. It is important that the nurse maintain a safe distance. For instance, he or she can remain at the door rather than entering the room unless necessary, according to Beck.
Also, to reduce occupational exposure, time is minimized to 30 minutes per shift, which involves bundling care to maximize efficiency and transferring care to other members of the health care team when the 30-minute limit is reached, Beck said. Between visits, nurses can use an intercom system to frequently assess patient safety risks, side effects, and patient needs.
Shielding in the hospital setting often involves lead or concrete walls to block radiation emissions. Some hospitals have private corner rooms, which are optimal for shielding, with the head of the bed facing the outside wall as opposed to an adjacent room.
These rooms are also often prepared to minimize exposure to others. Radiation signs are placed on the door, and the health care team uses designated equipment. Materials are left in the room for the patient’s entire hospital stay. All surfaces that the patient may touch, such as the toilet, faucet handles, and bedrails, are wrapped in plastic wrap.
Exposure is also limited by only assigning one patient treated with radiation to each nurse per shift. An entire assessment is completed before dosing, and nurses wear film badges during care to indicate the exposure level.
Additionally, to protect the patient and public, female patients must have negative serum pregnancy tests before receiving treatment. Antiemetics, lemon drops for improving salivation, increased hydration to flush radiation out of the body are all important for patient care. Patients must also wear gloves, and visitors must not be pregnant and be older than 18 years.
Patients are examined by nuclear medicine providers at least once a day and are not discharged unless their radiation level has reached 5 mrem per hour at 1 meter from the chest.
According to the American Thyroid Association, postdischarge safety guidelines suggest that patients maintain a personal distance greater than 6 feet and should not share personal hygiene products. They should also increase their hydration, shower at least the first 2 days, and use flushable wipes after using the bathroom.
Nevertheless, Beck said, due to ethical complications of experimentally exposing human subjects to radiation, research is lacking. So, for now, the ALARA principle and employing the concepts of time, distance, and shielding are the best way to minimize radiation exposure.
The research concluded that innovative strategies to teach the principles of radiation safety are the next step for advocating for radiation safety in nursing.
Beck M. Safe management of patients undergoing thyroid ablation. Presented at: Oncology Nursing Society (ONS) 39th Annual Congress; May 1-4, 2014; Anaheim, CA.