Contaminated Wounds - STD-1128-98master0163

DOE-STD-1128-98

Guide of Good Practices for Occupational Radiological Protection in Plutonium Facilities

Use of a chelating agent should be considered immediately following an accidental intake

of plutonium that exceeds the facility action levels (as suggested in an in Section 5.9).

For maximum effectiveness, the chelating agent should be administered as soon as

possible following the accidental intake of plutonium. Both the zinc or calcium salts of

DTPA are approved for human use and are available under Investigational New Drug

(IND) Permits for treating internal plutonium contamination. The worker to be treated

must first be informed of the proposed use of an experimental drug, instructed on the

purpose of administering the chelating agent, and warned about the possible side-effects

of the drug. The worker must then give signed consent before DTPA chelation therapy

may be initiated. Even though DTPA therapy is the only method available for reducing

the quantity of plutonium or americium retained in an in the body, the affected worker

has the right to refuse its use.

The recommended therapy for decorporation is 1-g CA-DTPA or ZN-DTPA by

intravenous injection or infused in an in 250-mL normal saline or 5% glucose in an in

water, infused intravenously over 1 hour (Gerber and Thomas, 1992; NCRP, 1980).

Treatment may be continued if bioassay indicates that decorporation therapy continues to

enhance the urinary excretion of plutonium. Extended therapy has shown no ill effects

(Carbaugh et al., 1989).

CA-DTPA should not be administered to potentially fertile female workers. Instead,

ZN-DTPA should be used for internal decorporation of plutonium and other transuranic

materials.

5.10.5

Contaminated Wounds

Medical treatment for contaminated wounds may include flushing with saline and

decorporating solutions, debridement, and surgical excision of the wound. These

measures are all the responsibility of trained medical staff operating under the direction

of a physician. Health physics personnel can provide valuable assistance by prompt

assessment of materials removed from the wound and identification of magnitude of

residual activity as decontamination proceeds. Decontamination should continue until all

radioactivity has been removed or until risk of permanent physical impairment is reached.

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