Radiation Implant Therapy
For this treatment, also called brachytherapy, the doctor uses implants of radioactive isotopes (encapsulated in seeds, needles, or sutures) to deliver ionizing radiation within a body cavity or interstitially to a tumor site. Implants can deliver a continuous radiation dose over several hours or days to a specific site while minimizing exposure to adjacent tissues. The implants may be permanent or temporary. Isotopes such as cesium 137 and 131, gold 198, iodine 125, iridium 192, palladium 103, and phosphorus 32 (32P) are used to treat cancers. (See Radioisotopes and their uses.)
Common implant sites include the brain, breast, cervix, endometrium, lung, neck, oral cavity, prostate, and vagina. Radiation implant therapy is commonly combined with external radiation therapy (teletherapy) for increased effectiveness.
For treatment, the patient is usually placed in a private room (with its own bathroom) located as far away from high-traffic areas as practical. If monitoring shows an increased radiation hazard, adjacent rooms and hallways may also need to be restricted. Consult your facility’s radiation safety policy for specific guidelines.
Equipment
Film badge or pocket dosimeter ▪ radiation precaution sign for door ▪ radiation precaution warning labels ▪ masking tape ▪ lead-lined container ▪ long-handled forceps ▪ Optional: lead shield and lead strip.
For Implants Inserted in the Oral Cavity or Neck
Emergency tracheotomy tray.
For Implants Inserted in the Anal Cavity or Vagina
Male T-binder ▪ sanitary napkins.
Preparation of Equipment
Place the lead-lined container and long-handled forceps in a corner of the patient’s room. Mark a “safe line” on the floor with masking tape 6′ (1.8 m) from the patient’s bed to warn visitors to keep clear of the patient to minimize their radiation exposure. If desired, place a portable lead shield in the back of the room to use when providing care.
Place an emergency tracheotomy tray in the room if an implant will be inserted in the oral cavity or neck.
Implementation
Make sure that an informed consent has been obtained and is documented in the patient’s medical record.1
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.5
Explain the treatment and its goals to the patient. Before treatment begins, review radiation safety procedures, visitation policies, potential adverse effects, and interventions for those effects. Also review long-term concerns and home care issues.
Place the radiation precaution sign on the door.
Make sure that all laboratory tests are performed before beginning treatment. If laboratory work is required during treatment, a technician (equipped with a film badge) should obtain the specimen, label the collection tube with a radiation precaution label, and alert the laboratory personnel before taking the samples to the laboratory. If urine tests are needed for 32P therapy, ask the radiation oncology department or laboratory technician how to transport these specimens safely.
Affix a radiation precaution warning label to the patient’s identification wristband.
Affix warning labels to the patient’s chart and Kardex to ensure staff awareness of the patient’s radioactive status.
Alert staff members that the patient is receiving radiation implant therapy by placing a radiation precaution warning in the patient’s medical record to prevent accidental exposure to radiation.
Wear a film badge or dosimeter at or above waist level during the entire shift. Turn in the radiation badge monthly or according to your facility’s protocol. Pocket dosimeters measure immediate exposures. In many facilities, these measurements aren’t part of the permanent exposure record but are used to ensure that nurses receive the lowest possible exposure.
Each nurse must have a personal, nontransferable film badge or ring badge that’s worn only within the work environment.6 Badges document each person’s cumulative lifetime radiation exposure. Only primary caregivers are badged and allowed into the patient’s room.
To minimize exposure to radiation, use the three principles of time, distance, and shielding: Time—plan to give care in the shortest time possible. Less time equals less exposure. Distance—work as far away from the radiation source as possible. Give care from the side opposite the implant or from a position allowing the greatest working distance possible. The intensity of radiation exposure varies inversely as the square of the distance from the source. Shielding—use a portable shield, if needed and desired.6
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