Management of the helpless patient after radioiodine ablation therapy – are we being too strict?

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Abstract

Background

A helpless patient was administered 1 GBq of 131I to ablate thyroid remnants post-thyroidectomy. The patient was quadriplegic, doubly incontinent and unable to swallow. Published data suggest that nursing staff may receive a total effective dose of 3400 μSv when dealing with such a patient for one 8 h shift per day for 7 days post-treatment.

Aim

To quantify the effective doses received by nursing staff on dealing with a helpless patient undergoing radioiodine ablation therapy.

Methods

After intravenous administration of 131I, the whole-body doses received by nursing staff were measured using electronic personal dosemeters for 7 days. The nursing staff recorded the times spent in contact with the patient and the activities performed during these times.

Results

The total effective dose received by nursing staff over 7 days was 148 μSv. A nurse working alone for one 8 h shift per day for 7 days could receive an effective dose of 91 μSv. The nursing staff spent an average of 23 min (standard deviation, 15 min) per 8 h shift dealing with the patient. Nursing duties were performed at a contact distance of approximately 0.5 m from the patient.

Conclusions

The nursing contact times required for the management of a helpless patient post-radioiodine therapy are lower than previously estimated. It is possible to successfully treat such a patient whilst keeping the effective doses to nursing staff within appropriate constraints. The measured nursing contact times provide an up-to-date summary of current nursing practice and will be a useful aid in the planning of future treatments.

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