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Vanderbilt University Online Radiation Safety Policies & Procedures Manual
Table of Contents

I. Required Training/Monitoring:

1. Clinical Staff (Physicians, Residents, Nurses and Care Partners) who care for patients receiving 1-131 Radiation Therapy
   1. Complete an initial orientation training that includes a web-based or direct training inservice, post-test, and completion of radiation "badge" form.
   2. Documentation of training is maintained by the unit manager and VEHS.
   3. On a monthly basis, receive a radiation badge from the unit badge representative. This badge is returned to the unit badge manager at the end of each month. Delinquent, lost and unreturned badges result in a late fee assessed to the unit.
   4. Exposure records for staff are maintained by VEHS. Annual exposure reports are provided by VEHS and distributed to applicable employees by the unit badge representative.
   5. Staff complete an annual competency training (web-based or direct training). A post-test evaluation is maintained on file by the unit manager.
   6. Competency training for nursing staff includes:
      1. General Radiation Safety Training
      2. Radiation safety training specific to radioiodine treatments
      3. Unit Specific training
          
2. Environmental Services/Dietary
   1. Radiation Safety training is performed during departmental orientation for new staff and annually thereafter.

II. Care Guidelines for Patients Receiving 1-131

A. Before the Patient is Dosed

1. Notify responsible physician that history, physicals or other procedures need to be performed before dosing.
2. Take all vital signs.
3. Take any needed specimens.
4. Obtain shoe covers, gloves and disposable paper gowns and place them outside the patient"s room.
5. Obtain disposable food trays.
6. Place linens on the bed after the room has been prepared. Also provide towels and washcloths.
7. Offer the patient a gown or pajamas so that their clothes will not become contaminated. Provide the patient with toiletries (toothpaste, toothbrush, soap, shampoo) for the same reason.
8. Provide the patient with a variety of drinks. Drinking lots of fluids will help them get rid of the radioactive material more quickly.
9. Obtain a radiation badge to wear while caring for the patient. Write your name on the badge and also indicate which badge you are using on the form.
10. Verify that VEHS has inspected the patient's room.

B. After the Patient has been Administered the Dose.

1. Put on your badge before entering the patient room. If you take care of the patient on more than one day, use the same badge each time.
2. Do not take specimens after the patient has been dosed, unless it is absolutely necessary. Blood and urine will be radioactive and will need to be labeled with a "Caution, Radioactive Material" label. (These labels are obtained from Radiation Safety.)
3. Always put on gloves and shoe covers before entering the room. Use barrier protection!
4. Also wear a disposable gown if you will need to change the linens or handle anything in the room that may touch you or your clothing.
5. After leaving the room, place shoe covers, gloves and gowns in the marked radioactive waste container outside the room. Stay on the floor where the plastic covering extends until you are ready to remove your shoe covers. Step onto the "clean" area after removing the shoe covers so as not to contaminate the uncovered floor with radioactive material. Since the plastic-covered area could be contaminated, do not stand on it without first putting on shoe covers.
6. Nothing must leave the room after the patient has been dosed. Once a day, Radiation Safety staff will come to remove trash.
7. Place patient's food on disposable trays.
8. Leave linens in the room after changing sheets.
9. If the patient vomits, place any contaminated linens in a large clear plastic bag, seal it with tape and leave it in the room. Contact the Radiation Safety staff member who is on-call for this patient and tell them that the patient has vomited. If the patient vomits within six hours of being dosed, the patient may need to be dosed again.
10. After the patient has gone home, do not enter the room until Radiation Safety has decontaminated the room and taken down the "Caution, this patient has been administered radioactive materials" door sign.

In Case of Cardiac Arrest

1. Use barrier protection.
2. Leave all equipment and disposable personal protective equipment in the patient's room.
3. Notify the Radiation Safety Officer (VEHS Emergency Pager 835-4965) immediately.

In Case of Death

1. Notify the referring physician and the Nuclear Medicine physician.
2. Notify the Radiation Safety Officer (VEHS Emergency Pager 835-4965) immediately.

Additional Information:

Visitors

1. Visitors may visit a patient after the patient is dosed for one hour in a 24-hour period. The time periods can be divided into 4 fifteen-minute visits or however the visitors would like utilize the time, but the total time must not exceed one hour.
2. Encourage visitors to call the patient on the telephone.
3. Visitors must put on gloves, shoe covers, and disposable gowns (barrier protection) before entering the room.
4. Once in the room, visitors must stay 6 feet or more away from the patient.
5. Visitors cannot use the patient's restroom or drink or eat anything in the room.
6. Visitors cannot enter the room if they are pregnant or may be pregnant.
7. Visitors must be at least 18 years old.

Environmental Services and Dietary staff

1. Do NOT enter the room after the patient has been dosed.
2. Once Radiation Safety has "cleared the room" of radioactivity, the Service Associate can enter the room and clean as appropriate.

Managing consumable supplies

Linens

1. Soiled linen is placed in yellow linen bags.
2. Bagged soiled linens remain in the patient bathroom for the entirety of the therapy.
3. Radiation Safety assesses linens for radiation prior to removing the sign on the door.
4. After Radiation Safety has "cleared the room" of radioactivity, the soiled linens are managed like other soiled linen from the unit.

Trash

1. All trash remains in the patient's room until cleared by Radiation Safety.
2. Trash bags are closed, securely tied, and placed in the bathroom.
3. After Radiation Safety has "cleared the room" of radioactivity, then trash is removed by Environmental Services when the room is cleaned.

Food Trays

1. Food trays are disposable or remain in the room during the entirety of the therapy.
2. After completion of the meal, disposable food trays are deposited in the trash for removal after the room is cleared by Radiation Safety.