Radioactive Iodine Therapy
Because the thyroid gland concentrates iodine, radioactive iodine 131 (131I) can be used to treat thyroid cancer. Usually administered orally, this isotope is used to treat postoperative residual cancer, recurrent disease, inoperable primary thyroid tumors, invasion of the thyroid capsule, or thyroid ablation as well as cancers that have metastasized to cervical or mediastinal lymph nodes or other distant sites.
Because 131I is absorbed systemically, all body secretions, especially urine, must be considered radioactive. For 131I treatments, the patient usually is placed in a private room (with its own bathroom) located as far away from high-traffic areas as practical. Adjacent rooms and hallways may also need to be restricted. Consult your facility’s radiation safety policy for specific guidelines.
In lower doses, 131I also may be used to treat hyperthyroidism. Most patients receive this treatment on an outpatient basis and are sent home with appropriate home care instructions.
Equipment
Film badges, pocket dosimeters, or ring badges ▪ radiation precaution sign for door ▪ radiation precaution warning labels ▪ waterproof gowns ▪ gloves ▪ clear and red plastic bags for contaminated articles ▪ plastic wrap ▪ absorbent plastic-lined pads ▪ masking tape ▪ radioresistant gloves ▪ trash cans ▪ emergency tracheotomy tray ▪ Optional: portable lead shield.
Preparation of Equipment
Assemble all necessary equipment in the patient’s room. Keep an emergency tracheotomy tray just outside the room or in a handy place at the nurses’ station. Place the radiation precaution sign on the door. Affix warning labels to the patient’s chart and Kardex to ensure staff awareness of the patient’s radioactive status.
Place an absorbent plastic-lined pad on the bathroom floor and under the sink; if the patient’s room is carpeted, cover it with such a pad as well. Place an additional pad over the bedside table. Secure plastic wrap over the telephone, television controls, bed controls, mattress, call bell, toilet seat, and flush handle. These measures prevent radioactive contamination of working surfaces. Keep a hazardous waste container lined with a clear and then a red leak-proof bag in the patient’s room. Keep objects in the patient’s room until they’ve been scanned and cleared by the radiation safety officer.1
Notify the dietitian to supply foods and beverages in disposable containers only and to provide disposable utensils.
Implementation
Review the patient’s health history for vomiting, diarrhea, productive cough, and sinus drainage, which could increase the risk of radioactive secretions.
Verify that the doctor has obtained informed consent and that the form is documented in the patient’s medical record.2
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.6
Explain the procedure and review treatment goals with the patient and his family. Before treatment begins, review your facility’s radiation safety procedures and visitation policies, potential adverse effects, interventions, and home care procedures.
Check for allergies to iodine-containing substances, such as contrast media and shellfish. Review the patient’s medication history for thyroid-containing or thyroid-altering drugs and for lithium carbonate, which may increase 131I uptake.
Review the patient’s health history for vomiting, diarrhea, productive cough, and sinus drainage, which could increase the risk of radioactive secretions.
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