Re: Delivery of I-131 therapy dose though a PEG

[carol marcus <csmarcus@ucla.edu>]

At 02:05 PM 6/15/00 -0500, you wrote:
>>Reply-To: "Jacobus, John (OD)" <JJacobus@ORS.OD.NIH.GOV>
>>
>>We have a patient who has experienced a progressive dysphagia and is no
>>longer able to swallow any liquids. Her dysphagia is thought to be from a "?
>>benign esophageal stricture, assumingly secondary to mediastinal radiation
>>and intense neck fibrosis. A recent CT and barium swallow by her local
>>physician has failed to identify either an esophageal mass or periesophageal
>>mass."
>>
>>Since she has no ability to swallow liquids, a PEG (percutaneous endoscopic
>>gastrostomy tube) was placed by her local physician, creating an opening
>>from the skin of her abdomen directly into her stomach. She places a feeding
>>tube into this PEG hole and consumes liquid nutrition 6 times/day. In regard
>>to her daily medications (i.e. Synthroid), she states she crushes it up and
>>then flushes it into her PEG tube. She states she has never put a capsule
>>into the PEG and is unsure if the diameter of the PEG hole would accept a
>>capsule.
>>
>>We are currently planning to do both a I-131 scan dose and I-131 therapy
>>dose.  Do you have any experience with this type of situation?
>>
>>-- John
>>
>>John Jacobus, MS
>>Health Physicist
>>National Institutes of Health
>>Radiation Safety Branch, Building 21
>>21 Wilson Drive, MSC 6780
>>Bethesda, MD  20892-6780
>>Phone: 301-496-5774      Fax: 301-496-3544
>>jjacobus@ors.od.nih.gov (W)
>>jenday1@email.msn.com (H)
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Dear John:

Yes, I have had this happen a couple of times.  Have your nuclear pharmacist
make up a liquid dose, and adjust the pH to physiologic range.  Inject IV
slowly through a 0.22 micron filter with a running normal saline IV.  Don't
mess with capsules or the stomach port.  Messy.  Flush the dose several
times with the normal saline because a lot can hang up in the filter.
Syncor has made this up for me a few times.

This is also the way to do it if the patient has frequent vomiting.

The syringe can be covered with a lead cylinder; if the volume is too much
put it in two syringes.  You can also rig up a remote injection
setup---probably your nuclear pharmacist can show you how.

Ciao, Carol  

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