ML003727855

Revision No. 006-04-0, Change No. PC-04 for OP-1903.035, Administration of Potassium Iodide.

ML003727855
Person / Time
Site:	Arkansas Nuclear
Issue date:	06/23/2000
From:	Entergy Operations
To:	Office of Nuclear Reactor Regulation
References
-RFPFR OP-1903.035, Revision 006-04-0
Download: ML003727855 (14)

Text

Arkiansas Nuclear One - Administrative Services Document Control Friday, June 23, 2000 Document Update Notification COPYHOLDER NO. 103 TO: NRC - WASHINGTON ADDRESS: DOC CNTRL DESK MAIL STOP OPl-17 WASHINGTON DC 20555 DOCUMENTNO: OP-1903.035 TITLE: ADMINISTRATION OF POTASSIUM IODIDE REVISION NO: 006-04-0 CHANGE NO: PC-04 SUBJECT. PERMANENT CHANGE (PC) this box is checked, please sign, date, and return transmittal in envelope provided J ANO-1 Docket 50-313 Q ANO-2 Docket 50-368 Signature Date A&b1

I ENTERGY OPERATIONS INCORPORATED ARKANSAS NUCLEAR ONE TITLE: ADMINISTRATION OF POTASSIUM IODIDE PROCAAORK PLAN NO. CHANGE NO.

1903.035 006-04-0 WORK PLAN EXP. DATE TC EXP. DATE NIA N/A SAFETY-RELATED IPTE SET# SYES ONO OYES ONO TEMP ALT I-_YES__NO When you see these TRAPS Get these TOOLS Time Pressure Effective Communication Distraction/interruption Questioning Attitude Multiple Tasks Placekeeping Over Confidence Self Check Vague or Interpretive Guidance Peer Check First Shift/Last Shift Knowledge Peer Pressure Procedures ChangelOff Normal Job Briefing Physical Environment Coaching Mental Stress (Home or Work) Turnover VERIFIED BY DATE TIME

-- I IAII I fl I I-AJF 0 I'UKM II I L= CHANGE NO VERIFICATION COVER SHEET 1000.006A 048-00-0 VERFIATONCOERSHETlooIo6I 080

ENTERGY OPERATIONS INCORPORATED ARKANSAS NUCLEAR ONE 61 of 70 PROC/WORK PLAN NO. CHANGE NO.

TITLE:Administration of Potassium Iodide 1 1903.035 006-04-0 NPROCEDURE OWORK PLAN, EXP. DATE .na PAGE I.. OF..__

TYPE OF CHANGE:

[3 NEW [3 REVISION 19 PC 0 TC 0 DELETION Procedure or Work Plan 03 EZ EXP. DATE.-_"/

AFFECTED SECTION: DESCRIPTION OF CHANGE: (For each change made, Include sufrficient detail to describe (Include step # If reason for the change.)

applicable)

Table of Contents Deleted the letter from "issurance" 1"3 Step 6.3 Step 6.2.4 Added step 6.2.4, "The TSC DirectoriEOF Director may approve the Issuance of KI via telecom."

Section 6.5 Changed the note at the beginning of section 6.5 to a step with the following textual changes:

Deleted wauthorize" and replace with "approve". Deleted "Completion of the KI documentation may be acomplished later at the convenience of the TSC Director/EOF Director.* and added

• Approval signature may be completed via telecom.

Step 6.5.8 Deleted "Attachment 7.5" and replaced with "1903.035CO.

Form 1903.035A Added "0 Check If approval Is via telecom." under EOF Director/TSC Director approval signature.

I ~L i~

FORM TITLE: 10N 1V0. 0480r" NO.

1000.006C 1O48-00-0 DESCRIPTION OF CHANGE

PROCJWORK PLAN NO. PROCEDUREIWORK PLAN TITLE: PAGE: I Of 11 1903.035 ADMINISTRATION OF POTASSIUM IODIDE CHANGE: 006-04-0 K.>: TABLE OF CONTENTS SECTION PAGE NO.

1.0 Purpose ............................................................. 2 2.0 Scope ............................................................... 2 3.0 References .......................................................... 2 4.0 Definitions ......................................................... 2 5.0 Responsibility and Authority ............................................ 2 6.0 Instructions ........................................................ 3 6.1 Initiating Conditions ......................................... 3 6.2 Assessing the Need to Issue KI ................................ 3 6.3 KI Issuance Requirements ...................................... 3 6.4 Distribution of KI ............................................. 4 6.5 Secondary TSC .................................................. 4 6.6 Final Conditions ............................................... 5 Attachments and Forms ................................................... 6 7.1 Attachments 7.1.1 Attachment 1 - Thyroid Committed Dose Equiv.

Graph ................................................ 7 7.1.2 Attachment 2 - Potassium Iodide Precaution Leaflet .............................................. 8 7.2 Forms 7.2.1 Form 1903.035A - Potassium Iodide Administration ...................................... 9 7.2.2 Form 1903.035E - KI Issue Record .................... 10 7.2.3 Form 1903.035C - ANO Medical Questionnaire Iodine Sensitivity .................................. 11

PROCJWORK PLAN NO. PROCEDUREIWORK PLAN TITLE: PAGE: 2 of 11 1903.035 ADMINISTRATION OF POTASSIUM IODIDE CHANGE: 006-04-0 1.0 PURPOSE To provide guidance for the administration of Potassium Iodide (KI) to minimize uptake of radioiodines in the thyroid gland.

2.0 SCOPE This procedure applies to all ANO and contractor employees prior to a planned exposure to radioiodine and after an accidental exposure.

3.1 REFERENCES

USED IN PROCEDURE PREPARATION:

3.1.1 EPA 400-R-92-001, Manual of Protective Action Guides and Protective Actions for Nuclear Incidents 3.1.2 Patient Package Insert for Commercial Packaged Potassium Iodide 3.1.3 ANO Emergency Plan

3.2 REFERENCES

USED IN CONJUNCTION WITH THIS PROCEDURE:

3.2.1 1903.033, "Protective Action Guidelines for Rescue/Repair and Damage Control Teams" 3.2.2 1903.065, "Emergency Response Facility - Technical Support Center (TSC) 3.2.3 1903.067, "Emergency Response Facility - Emergency Operations Facility (EOF) 3.3 RELATED ANO PROCEDURES:

1903.060, "Emergency Supplies and Equipment" 3.4 REGULATORY CORRESPONDENCE CONTAINING NRC COMMITMENTS WHICH ARE IMPLEMENTED IN THIS PROCEDURE: Commitments noted in [BOLD]

3.4.1 Letter 0CNA049709 Inspection report 97-10, 6.4 NOTE 4.0 DEFINITIONS None 5.0 RESPONSIBILITY AND AUTHORITY 5.1 The Radiation Protection and Radwaste (RP&RW) Manager is responsible for the implementation of this procedure for on-site emergency response personnel.

5.2 The Radiological Environmental Assessment Manager (REAM) is responsible for the implementation of this procedure for off-site emergency response personnel.

PROCJWORK PLAN NO. PROCEDUREIWORK PLAN TITLE: PAGE: 3 of 11 1903.035 ADMINISTRATION OF POTASSIUM IODIDE CHANGE: 006-044 5.3 The TSC Director is responsible for authorizing the administration of KI for on-site emergency response personnel.

5.4 The EOF Director is responsible for authorizing the administration of KI for offsite emergency response personnel.

6.0 INSTRUCTIONS 6.1 INITIATING CONDITIONS This procedure shall be initiated whenever a dose commitment of 10 rem CDE or greater for the thyroid is likely to be received by an individual.

NOTE If indications other than air sample results (for example; RDACS, failed fuel monitor, etc.) indicate the presence (or potential presence) of significant amounts of radioactive iodine, the RP&RW Manager or REAM may recommend the issuance of KI.

6.2 ASSESSING THE NEED TO ISSUE KI 6.2.1 Obtain a copy of Attachment 1, Thyroid Committed Dose Equivalent Graph, and estimate the dose commitment for the thyroid.

6.2.2 Verify the calculations/measurements/estimates and record the results on Form 1903.035A, Potassium Iodide Administration Form.

6.2.3 Report the results to the TSC Director/EOF Director and advise them as to the need to issue KI in accordance with this procedure.

6.2.4 The TSC Director/EOF Director may approve the issuance of KI via telecom.

6.3 KI ISSUANCE REQUIREMENTS 6.3.1 When thyroid CDE is estimated to be 10 rem or greater.

6.3.2 The TSC Director/EOF Director shall designate the individuals who will receive KI and the individuals to administer KI.

6.3.3 The individual(s) to receive KI shall voluntarily elect to take KI.

6.3.4 The individual to receive KI shall read Attachment 2, Potassium Iodide Precaution Leaflet, and complete the appropriate sections of Form 1903.035A, Potassium Iodide Administration Form, and Form 1903.035C, ANO Medical Questionnaire: Iodine Sensitivity.

PROCJWORK PLAN NO. PROCEDUREIWORK PLAN TITLE: PAGE: 4 of 11 1903.035 ADMINISTRATION OF POTASSIUM IODIDE CHANGE: 006-04

> 6.4 DISTRIBUTION OF KI

[NOTE]

KI in stored in the following locations:

A. TSC Emergency Kit B. Onsite Radiological Monitoring Kit (located in the OSC)

C. EOF Emergency Kit D. Field Monitoring Kits (located in the EOF) 6.4.1 Assemble the individuals who were designated to receive KI and the individuals to administer the KI.

6.4.2 Provide the individuals designated to receive KI with copies of:

A. Form 1903.035A, Potassium Iodide Administration Form B. Attachment 2, Potassium Iodide Precaution Leaflet C. Form 1903.035C, ANO Medical Questionnaire: Iodine Sensitivity 6.4.3 The individuals designated to administer KI should obtain copies of Form 1903.035B, KI Issue Record.

6.4.4 Ensure personnel read and/or complete the appropriate sections of the Forms and Attachments provided in Step 6.4.2.

6.5 GUIDELINES FOR THE ADMINISTRATION OF KI The TSC Director/EOF Director can approve the administration of KI in the field after the Field Monitoring Team members have complied with the guidelines of this procedure. Approval signature may be completed via telecom.

6.5.1 If possible, KI should be administered approximately one half hour before exposure for maximum blockage.

6.5.2 Final uptake is halved if KI is administered within 3-4 hours after exposure.

6.5.3 Little benefit is gained with KI administration 10-12 hours after exposure.

6.5.4 Once the KI is taken and the Iodine concentration is verified or the calculated dose determined, the tablets should be issued for a minimum of six (6) to a maximum of ten (10) consecutive days. One tablet is issued each day.

PROC.NVORK PLAN NO. PROCEDURE/WORK PLAN TITLE: PAGE: 5 of 11 1903.035 ADMINISTRATION OF POTASSIUM IODIDE CHANGE: 006-04-0 6.5.5 In all cases where airborne contamination is anticipated, the use of proper respiratory equipment shall be considered.

6.5.6 Verify that each individual receiving KI has completed and signed Forms 1903.035A and 1903.035C.

6.5.7 Verify that there are no "YES" blocks checked on Form 1903.035C, ANO Medical Questionnaire: Iodine Sensitivity.

6.5.8 Individuals who have answered "YES" to any question on 1903.035C, ANO Medical Questionnaire: Iodine Sensitivity, will initially be considered to be iodine sensitive and must be treated as follows:

A. The individuals will be relocated or replaced to eliminate or minimize the uptake of radioiodine in the thyroid gland, or B. The individuals WILL NOT receive KI without the RP&RW Manager's/REAM's authorization (after evaluation of the "YES" answer and the TSC Director's/EOF Director's concurrence).

6.5.9 Issue each individual designated to receive KI one (1) 130 mg KI tablet.

6.5.10 Record the issuance on Form 1903.035B, KI Issue Record.

6.5.11 Forward all completed paperwork to the RP&RW Manager/REAM.

6.5.12 Individuals listed on Form 1903.035B, KI Issue Record, should have a whole body count and/or bioassay analysis at the earliest opportunity.

6.5.13 Where possible, whole body counts and/or bioassay analysis should be given on a regular basis throughout the KI issue period to verify the effectiveness of the KI and to estimate dose commitment.

6.6 FINAL CONDITIONS 6.6.1 Each individual whose estimated exposure to radioiodine was equal to or exceeded 10 rem has been identified and administered KI, as appropriate.

6.6.2 All necessary forms are completed and reviewed by the RP&RW Manager/REAM and the TSC Director/EOF Director.

6.6.3 Completed documentation collected and assembled by the RP&RW Manager and/or REAM for post-event assessments and records.

6.6.4 Each individual who was exposed has been scheduled for bioassay analysis.

PROC.NJORK PLAN NO. PROCEDUREIWORK PLAN TITLE: PAGE: 6 of 11 1903.035 ADMINISTRATION OF POTASSIUM IODIDE CHANGE: 006-04-0 7.0 ATTACHMENTS AND FORMS 7.1 ATTACHMENTS 7.1.1 Attachment 1 Thyroid Committed Dose Equivalent Graph 7.1.2 Attachment 2 Potassium Iodide Precaution Leaflet 7.2 FORMS 7.2.1 Form 1903.035A - Potassium Iodide Administration 7.2.2 Form 1903.035B - KI Issue Record 7.2.3 Form 1903.035C - ANO Medical Questionnaire: Iodine Sensitivity

PROC./WORK PLAN NO. PROCEDURE/WORK PLAN TITLE: PAGE: 7 of 11 1903.035 ADMINISTRATION OF POTASSIUM IODIDE I CHANGE: 005-04-0 ATTACHMENT 1 THYROID COMMITTED DOSE EQUIVALENT GRAPH S2 I

I j.

I 1.00E-06 1.00E-05 1.00E-04 4.80E-04 1-131 Concentration (uCIlcc) I Protection Factor

PROCJ.WORK PLAN NO. PROCEDUREIWORK PLAN TITLE: PAGE: 8 of 11 1903.035 ADMINISTRATION OF POTASSIUM IODIDE CHANGE: 006-04-0 I

ATTACHMENT 2 POTASSIUM IODIDE PRECAUTION LEAFLET THYROID BLOCKING AGENT INSTRUCTION SHEET THYRO-B)LOC TABLES In a radiation emergency, radioactive kxfine may be released inthe air.

(POTASSIUM IOIDE TABIZM, USP) This material may be swamowed. NImay enter the thyrold rbreathd gland and damage IL The damage would robably not show Itself for (pron-uned po-TASS-eamEYEBoh-dycd]) years.

(abbr9ViMt& X0)

Ifyou take potassium Iodide, Itwill m up your thyrod gland. This radiuces n chance t harmful radioactive iodine wo enter the thyroid gland.

TAKE POTASSIUM IODIDE ONLY WHEN AUTHORIZED.

IN A RADIATION EMERGENCY, RADIOACTIVE IODINE COULD BE RELEASED LNTO TE* AIR. POTASSIUM WHO SHOULD NOT TAKE POTASSIUM IODIDE IODIDE (AFORM OF IODINE) CAN HELP PROTECT YOU. The only people who should not take potassium Iodide are people who know they ae allergic to Iodide. You may take potassium Iodidle even If IF YOU ARE TOLD TO TAKE THIS MEDICINE, TAKE IT you am taidng medicims for a thyroid problem (for evamle, tayridd ONE TIME EVERY 24 HOURS. DO NOT TAKE IT MORE honone or anlthyrold drug). Pregnant end nurms women masy also OFTEN. MORE WILL NOT NELP YOU AND MAY takethisdaug.

INCREASE THE RISK OF UIDE EFFECrS. DO NOT TAKE THIS DRUG IF YOU KNOW YOU ARE ALLERCIC TO HOW AND WHEN TO TAKE POTASSIUM IODIDE IODIDE (SEE SIDE EFFECTS BELOW.) Potassium Iodide should be taken as soon as possible asler authortlzaton.

You should take ane dos ever 24 houn. More will not help you because the thrdd can "hold" erey bilted mnounts of lodine. Larger doses will Incrase the risk of side effects. You wVA probably be told not to take the drug for more than ten days.

INDICATIONS THYROID BLOCIONG INA RADIATION EMERGENCY ONLY. SIDE EFFECTS Usually, side effects of potassium Iodide happen when people take higher doses Icr a logI**e. You should be careful not to take more lIen the DIRECTIONS FOR USE recocnmended dose or take Itfor longer than you are told. $ide effects Use only as directed In the event of . radiation emergency. are unlikely because cf'the low dose and the short time you wil be taking the drug.

DOSE Tablets: One (1) tablet once a day. Possble sdde effects kIcude sldn rashes, swelling of the SAaUuY glands.

and liod*sm" (metallic taste, burnin mouth and throat, sore teeth arnd Take for 10 days urless directed atherwise by the Emergency Director or gums, symptoms of a head cold, and sometimes stomach upset and Offslt Emergency Coordinator. diarrhea).

Store at controlled roon temperature between 15, and 301C (W9'to 68W A few people have an allergic reaction with more serious sylmptoms.

F). Keep container ightly closed and protect from light. These could be fever and Joint pains, or swelling of parts of the face and body and at tines sevee shortness of breath nrequtin hnmedilate mnedicall WARNING attention.

Potassfmn odide shoud not be used by people aelel to Iodie. Keep out of the reach of children. In case of overdose or allergic reaction, Takdng lodide may rarely cause everacMty of the thyroid gland, contact a physician. underacivity of the thyrold gland, or enlargement of th thyrodd gland (goft-DESCRIPTION Each THYRO-BLOCK TABLET contains 130 mg of pobtasu iodide. WHAT TO DO IF SIDE EFFECTS OCCUR Other Ingredients: magnesium stearate, mIcrocrystalline cellulose, silica If the aide effects are severe orlf you have an altegio reaction atop takdng gel, sodium thlosuffate. potassium Iodide. Then, If possible, call a doctor or public health authority for hInsructions.

N1OW SUPPLIED HOW POTASSIUM IODIDE WORKS THYRO-SLOCK TABLETS (Potassium Iodide Tablets. USP) boates of Certain forms of Iodine help your tyrold gland work right. Most people 14 tablets (ND* a03704X72-20). Each white, roun, scored tablet get the Iodine they need from foos Ike Iodized sal or fish. The thyroid contains 130 mg potassium iodide.

can 'store' or hold only a certain *mount of iodine.

Page 9 of 11 Potassium Iodide (KI) Administration Form Name of Exposed Individual:

Last First Middle Social Security Number: Badge Number:

Duration of Exposure: 1-131 Concentration:

Minutes ILCi/cc iii air Estimated Thyroid Dose Commitment: (Check One) 0 <10 Rem DZ 3lC Rem Date of Exposure:

Respiratory Protection Worn During Exposure: (Check One) ] Yes I] No Respirator Protection Factor:_ _

Known Iodide Allergy/Previous Allergic Reaction: (Check One) 0 Yes 0 No I Verify that I have read and understand the precaution leaflet and I understand that taking thyroid blocking agent (KI) is strictly voluntary.

K-. I (Check One) 0 Do Dl Do Not choose to take KI.

Signature of Exposed Individual Date Approved:

EOF Director/TSC Director Date 0 Check if approval is via telecom.

KI Tablets Issued By:

Signature Date Notes:

FORM TITLE:

POTASSUIM IODIDE ADMINISTRATION I CHANGE:.%

1903.035A REV.

1 006.04-0

Page 10 of 11 KI ISSUE RECORD KI ADMINISTRATION 1 2 3 4 5 f0 6 7 8 9 Date Date Date Date Date Date Date Date Date Date Int. Int. Int. int. Int. int. Int. Int. Int. JInt..

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FORM TITLE: CHANGE:. REV.

KI ISSUE RECORD 1903.035B 006-04-0

mi - - d' Page 11 of 11 MEDICAL QUESTIONAIRE: IODINE SENSITIVITY Name: J SS No:

LAST FIRST MIDDLE Badge Number: Company:_______ Dept:

Please answer the below listed questions and mark the appropriate box.

NO. QUESTION YES NO

1. Have you any known allergies? If so, please describe major severity of allergy and medications taken, if any.

2. When eating seafood or shellfish, do you suffer from symptoms of stomach or bowel upset or skin eruption? If so, explain.

3. Has any physician told you that you have a sensitivity to iodine?

4. Have you ever had a gallbladder dye test, kidney x-ray requiring dye injection, thyroid isotope scan? If so, any reactions?

Please explain any yes answers:

Signature: Date:

I FORM TITLE: ANO MEDICAL QUESTIONNAIRE-IODINE SENSITIVITY 1903.035C I CHANGE: 006-04-0 REV.