ML003727855
| 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. TO: ADDRESS: DOCUMENT NO: TITLE: REVISION NO: CHANGE NO: SUBJECT.103 NRC -WASHINGTON DOC CNTRL DESK MAIL STOP OPl-17 WASHINGTON DC 20555 OP-1903.035 ADMINISTRATION OF POTASSIUM IODIDE 006-04-0 PC-04 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 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 SET# SAFETY-RELATED IPTE SYES ONO OYES ONO TEMP ALT I-_YES_ _NO When you see these TRAPS Time Pressure Distraction/interruption Multiple Tasks Over Confidence Vague or Interpretive Guidance First Shift/Last Shift Peer Pressure ChangelOff Normal Physical Environment Get these TOOLS Effective Communication Questioning Attitude Placekeeping Self Check Peer Check Knowledge Procedures Job Briefing Coaching Mental Stress (Home or Work) Turnover VERIFIED BY DATE TIME -- I IAII I fl I I-AJF 0 VERFIATONCOERSHETlooIo6I 080 I I'UKM II I L=CHANGE NO 1000.006A 048-00-0 VERIFICATION COVER SHEET ENTERGY OPERATIONS INCORPORATED ARKANSAS NUCLEAR ONE 61 of 70 TITLE:Administration of Potassium Iodide PROC/WORK PLAN NO. CHANGE NO. 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: (Include step # If applicable)
Table of Contents Step 6.3 Step 6.2.4 Section 6.5 Step 6.5.8 Form 1903.035A FORM TITLE: DESCRIPTION OF CHANGE: (For each change made, Include sufrficient detail to describe reason for the change.) Deleted the letter 1"3 from "issurance" Added step 6.2.4, "The TSC DirectoriEOF Director may approve the Issuance of KI via telecom." 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.
Deleted "Attachment 7.5" and replaced with "1903.035CO.
Added "0 Check If approval Is via telecom." under EOF Director/TSC Director approval signature.
I ~L i~DESCRIPTION OF CHANGE 10N 1V0 .0480r" NO. 1000.006C 1O48-00-0 PROCJWORK PLAN N
O. PROCEDURE
IWORK 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
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2 6.0 Instructions
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3 6.1 Initiating Conditions
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3 6.2 Assessing the Need to Issue KI ................................
3 6.3 KI Issuance Requirements
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3 6.4 Distribution of KI .............................................
4 6.5 Secondary TSC ..................................................
4 6.6 Final Conditions
...............................................
5 S7.0 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
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9 7.2.2 Form 1903.035E
-KI Issue Record ....................
10 7.2.3 Form 1903.035C
-ANO Medical Questionnaire Iodine Sensitivity
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11 PROCJWORK PLAN N
O. PROCEDURE
IWORK 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.
3.0 REFERENCES
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.
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O. PROCEDURE
IWORK 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 N
O. PROCEDURE
IWORK 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 N
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/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.
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O. PROCEDURE
IWORK 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 7.1.2 Attachment 2 7.2 FORMS 7.2.1 Form 1903.035A 7.2.2 Form 1903.035B 7.2.3 Form 1903.035C Sensitivity Thyroid Committed Dose Equivalent Graph Potassium Iodide Precaution Leaflet -Potassium Iodide Administration
-KI Issue Record -ANO Medical Questionnaire:
Iodine PROC./WORK PLAN N
O. 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 N
O. PROCEDURE
IWORK PLAN TITLE: PAGE: 8 of 11 1903.035 ADMINISTRATION OF POTASSIUM IODIDE I CHANGE: 006-04-0 ATTACHMENT 2 POTASSIUM IODIDE PRECAUTION LEAFLET THYROID BLOCKING AGENT INSTRUCTION SHEET INDICATIONS THYROID BLOCIONG IN A RADIATION EMERGENCY ONLY. DIRECTIONS FOR USE Use only as directed In the event of .radiation emergency.
DOSE Tablets: One (1) tablet once a day. Take for 10 days urless directed atherwise by the Emergency Director or Offslt Emergency Coordinator.
Store at controlled roon temperature between 15, and 301C (W9' to 68W F). Keep container ightly closed and protect from light. WARNING 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, contact a physician.
DESCRIPTION Each THYRO-BLOCK TABLET contains 130 mg of pobtasu iodide. Other Ingredients:
magnesium stearate, mIcrocrystalline cellulose, silica gel, sodium thlosuffate.
HOW POTASSIUM IODIDE WORKS Certain forms of Iodine help your tyrold gland work right. Most people get the Iodine they need from foos Ike Iodized sal or fish. The thyroid can 'store' or hold only a certain of iodine.THYRO-B)LOC TABLES (POTASSIUM IOIDE TABIZM, USP) (pron-uned po-TASS-eamEYEBoh-dycd]) (abbr9ViMt&
X0) TAKE POTASSIUM IODIDE ONLY WHEN AUTHORIZED.
IN A RADIATION EMERGENCY, RADIOACTIVE IODINE COULD BE RELEASED LNTO AIR. POTASSIUM IODIDE (AFORM OF IODINE) CAN HELP PROTECT YOU. IF YOU ARE TOLD TO TAKE THIS MEDICINE, TAKE IT ONE TIME EVERY 24 HOURS. DO NOT TAKE IT MORE OFTEN. MORE WILL NOT NELP YOU AND MAY INCREASE THE RISK OF UIDE EFFECrS. DO NOT TAKE THIS DRUG IF YOU KNOW YOU ARE ALLERCIC TO IODIDE (SEE SIDE EFFECTS BELOW.)In a radiation emergency, radioactive kxfine may be released in the air. This material may be rbreathd swamowed.
NI may enter the thyrold gland and damage IL The damage would robably not show Itself for years. If you take potassium Iodide, It will m up your thyrod gland. This radiuces n chance t harmful radioactive iodine wo enter the thyroid gland. WHO SHOULD NOT TAKE POTASSIUM IODIDE 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 you am taidng medicims for a thyroid problem (for evamle, tayridd honone or anlthyrold drug). Pregnant end nurms women masy also takethisdaug.
HOW AND WHEN TO TAKE POTASSIUM IODIDE 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. SIDE EFFECTS Usually, side effects of potassium Iodide happen when people take higher doses Icr a log You should be careful not to take more lIen the recocnmended dose or take It for longer than you are told. $ide effects are unlikely because cf'the low dose and the short time you wil be taking the drug. Possble sdde effects kIcude sldn rashes, swelling of the SAaUuY glands. and (metallic taste, burnin mouth and throat, sore teeth arnd gums, symptoms of a head cold, and sometimes stomach upset and diarrhea).
A few people have an allergic reaction with more serious sylmptoms.
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 attention.
Takdng lodide may rarely cause everacMty of the thyroid gland, underacivity of the thyrold gland, or enlargement of th thyrodd gland (goft-WHAT TO DO IF SIDE EFFECTS OCCUR If the aide effects are severe orlf you have an altegio reaction atop takdng potassium Iodide. Then, If possible, call a doctor or public health authority for hInsructions.
N1OW SUPPLIED THYRO-SLOCK TABLETS (Potassium Iodide Tablets. USP) boates of 14 tablets a03704X72-20).
Each white, roun, scored tablet contains 130 mg potassium iodide.
Page 9 of 11 Potassium Iodide (KI) Administration Form Name of Exposed Individual:
Last Social Security Number: Duration of Exposure: First Middle Badge Number: 1-131 Concentration:
Minutes ILCi/cc ii Estimated Thyroid Dose Commitment: (Check One) 0 <10 Rem DZ 3 lC 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 i air Rem 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 Approved:
EOF Director/TSC Director 0 Check if approval is via telecom.KI Tablets Issued By: Date Date Date Signature Notes: FORM TITLE: POTASSUIM IODIDE ADMINISTRATION CHANGE:.%
REV. I 1903.035A 1 006.04-0 Int.Int.Int.int.Int.int.Int.Int.Int.KI ADMINISTRATION 1 2 3 4 5 6 7 8 9 f0 Date Date Date Date Date Date Date Date Date Date Page 10 of 11 KI ISSUE RECORD Name: SS No: Name: SS No: Name: SS NO: Name: SS NO: Name: SS No: Name: SS NO: Name: SS No: Name: SS No: Name: SS No: FORM TITLE: CHANGE:. REV. KI ISSUE RECORD 1903.035B 006-04-0 JInt..
Page 11 of 11 MEDICAL QUESTIONAIRE:
IODINE SENSITIVITY FIRST MIDDLE SS No: 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: Name: LAST I FORM TITLE: CHANGE: REV. ANO MEDICAL QUESTIONNAIRE-IODINE SENSITIVITY I 1903.035C 006-04-0 mi --d'J