Contaminated Wounds - doe-std-1128-98

DOE-STD-1128-98

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

intake of plutonium that exceeds the facility action levels (as suggested 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 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 250-mL normal saline or 5% glucose 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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