Dialyzing a Radioactive Patient

Introduction: Radioactive iodine (RAI) ablation is part of standard therapy for thyroid carcinoma to destroy remaining cancerous thyroid tissue, treat microscopic residual disease and reduce recurrence. RAI is administered as a capsule, gets absorbed through the gastrointestinal tract, and subsequently absorbed by thyroid gland. Iodine 131 (I131) emits beta radiation which leads to DNA and tissue damage. It is predominantly excreted by the kidneys therefore there is decreased excretion in patients with chronic kidney disease (CKD) and on dialysis. Hence, special considerations should be undertaken in patients that are anuric and on hemodialysis (HD). Case Description: A 55 year old male with a history of End Stage Renal disease (ESRD) on HD and Papillary thyroid carcinoma was admitted to the hospital; he underwent total thyroidectomy with neck dissection. He was scheduled to receive RAI to ensure complete destruction of malignant tissue. He was isolated in his room rather that transporting to the dialysis unit and risking exposure to patients and staff. He was dialyzed a day prior to administration of RAI and monitored for the next 48 hours for dialysis needs. Dialysis nursing staff was trained and equipped with radiation meters prior to dialyzing him. Monitoring was done in collaboration with the division of nuclear medicine (NM). The patient was dialyzed 2 days after RAI administration; the dialysis machine was also isolated after use. All HD disposables were kept in the patient room, in a special bin and removed by the radiation protection team. The patient was cleared from radiation precautions after one dialysis session. Discussion: Multiple aspects must be considered when managing a radioactive dialysis dependent patient, including proximity to the patient, total contact time, exposure of the HD machine to the radiation source, disposal of water, materials and spills. In patients with normal renal function, RAI is administered in an outpatient setting. The literature review revealed lack of standardized protocols for taking care of such patients; 1 published article was utilized as an outline to develop the guide used in this case. Management of dialysis-dependent patients should include a multidisciplinary approach to ensure proper planning, excellent patient care while assuring staff safety and prevent exposure to other patients.