Re: EVACUATION OF BRACHYTHERAPY PATIENTS

[Karin Gordon <kgordon@cc.UManitoba.CA>]

Dear Ray,

Just to make sure we are talking about the same thing, I assume you are dealing with 
gynecological brachtherapy - low-dose-rate, probably using Cs-137  with manual insertion 
and removal of source rods into the tandems.  When we were doing these, it was decided 
that nurses should be trained to remove the source rods in the event of an emergency - 
and we foresaw the following most likely scenarios where that might be necessary:

1. evacuation in case of fire or medical emergency (cardiac or respiratory arrest, 
seizure, etc) 
2. if the patient had tampered with the tandem by pulling it out of position, 
3. if a uncooperative or confused patient had unscrewed a tandem cap causing the source 
rod to change position.    

I developed an illustrated written instruction  package on Cs-137 source rod removal for 
the nursing staff, and co-delivered the in-service sessions to the nursing staff with 
the senior brachytherapy radiation therapist.  We used a skeleton model of the pelvis 
with actual tandems in place, and after the verbal and demonstration training session,  
had each of the trainee nurses remove dummy source rods from the tandems and transfer 
them to the mobile Pb pig in the room. It's important that they have this kind of 
hands-on experience in their training.  

The written instruction package, in-service lecture and hands-on demonstration session  
were all developed as part of our hospital's formal Transfer-of-Function system, which 
we use whenever nurses are given responsibility for and must gain competence in a 
medical task which formally had been performed by a physician or specialized 
technologist, etc.  Proposed transfers-of-function have to be approved by a review panel 
and senior hospital management.  Of course we kept track of those who had participated 
in the training sessions, and it was the head nurse's responsibility to ensure that new 
ward staff were trained in this skill as they were hired and that refreshers were given 
at least once annually. 

We are no longer doing LDR manual source placement brachytherapy, having switched over 
to an automated HDR system.

If you are interested in reviewing our emergency brachytherapy source removal 
instruction package, please contact me and I'll mail or fax it it to you.

Karin Gordon
RAdiation Safety Office		phone	(204) 787-2903
Health Sciences Centre		fax	(204) 787-1313
GC-214, 820 Sherbrook St.	e-mail	KGordon@cc.UManitoba.ca 
Winnipeg, MB. Canada
R3A 1R9




RAY FONG wrote:
> 
> We are discussing evacuation plans for medical brachytherapy patients.  The
> question was brought up if we should allow nursing staff to remove the
> tandem prior in evacuating these patients from the ward to a safe site
> outside the hospital.  Any opinions?
> Andy Waters
> Radiology Dept.
> Naval Medical Center, San Diego
> 
> Comm:(619) 532-8715