SAN DIEGOLead aprons, radiation badges, and patient laundry are not the normal concerns of nurses. But as new radioimmunotherapy agents are evaluated and introduced into practice, nurses will need to familiarize themselves with radiation safety precautions, said Patricia A. Kramer, RN, MSN, a San Francisco-based oncology nurse educator and consultant. Patient education and instruction throughout the whole process is key.
Speaking at a Cure for Lymphoma Foundation Symposium at the Oncology Nursing Society’s 26th Annual Congress, Ms. Kramer reviewed issues involved in the administration of I-131 tositumomab (Bexxar™), a radiolabeled monoclonal antibody under review by the FDA for the treatment of non-Hodgkin’s lymphoma. Tositumomab emits beta and gamma radiation. Gamma radiation has a half-life of 8 days.
Administering tositumomab requires strict radiation safety procedures and may require overnight hospitalization because the patient is radioactive.
"The radiation safety procedures we need to familiarize ourselves with when using this agent have to do with utilizing the principles of time, distance, and shielding," Ms. Kramer said. Decreasing one’s time spent with a patient receiving tositumomab will decrease one’s radiation exposure. Increasing distance from a patient will also decrease radiation exposure, she said.
Radiation precautions, as outlined below, should be observed for 1 week, she said. Patients need to maintain a distance of approximately 6 feet from other people whenever possible.
All staff need to wear monitoring badges to monitor their radiation exposure and lead aprons when coming into contact with radioimmunotherapy patients. The aprons will absorb up to 99% of radiation, she said, but pregnant nurses cannot work with these patients. Special rooms must also be designated within the institution for administration of radiolabeled antibodies.
A recent change in the standards set by the Nuclear Regulatory Commission makes it possible in some cases for patients to receive radioimmunotherapy as outpatients. The new discharge criteria are dose-based, determined by patient-specific calculations or the use of a default table.