ML20148T022
| ML20148T022 | |
| Person / Time | |
|---|---|
| Site: | Arkansas Nuclear  |
| Issue date: | 07/01/1997 |
| From: | ENTERGY OPERATIONS, INC. |
| To: | |
| References | |
| NUDOCS 9707080369 | |
| Download: ML20148T022 (13) | |
Text
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, Arkansas Nuclear One - Administrative Senices l Document Control 1 Tuesday, July 01,1997 Document Update Notification 1
1 COPYHOLDER NO: 103 TO: NRC - WASIIINGTON ADDRESS: DOC CNTRL DESK MAIL STOP PI-37 WASIIINGTON DC 20555 l
DOCUMENTNO: OP-1903.035 1
TITLE: ADM POTASSIUM IODIDE IWVISIONNO: 06-00-00 CHANGE NO: AP-06
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SUBJECT:
NEW REVISION ,
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,O I FORM TITLE: FORM NO. REV.
LIST OF AFFECTED PAGES 1000.006A 45 t
y PROCJWORK PLAN NO. PROCEDURE / WORK PLAN TITLE: PAGE: 1 Of 11
. 1903.035 ADMIN 18TRATION OF POTASSIUM IODIDE REV: $
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d TABLE OF CONTENTS V
SECTION PAGE NO. )
1.0 Purpose............................................................. 2 i 2.0 Scope............................................................... 2 1
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 Issurance Requirements .................................. 3 6.4 Distribution of KI ......................................... 4 6.5 Secondary TSC .............................................. 4
,s 6.6 Final Conditions ........................................... 5 t
(, 7.0 Attachments and Forum............................................... 6 7.1 Attachments 7.1.1 Attachment 1 - Thyroid Committed Dose Equiv. l Graph............................................ 7 7.1.2 Attachment 2 - Potassium Iodide Precaution i I
Leaflet.......................................... 8 7.2 Forms 1
7.2.1 Form 1903.035A - Potassium Iodide !
Administration................................... 9 7.2.2 Form 1903.035B - K1 Issue Record................. 10 7.2.3 Form 1903.035C - ANO Medical Questionnaire Iodine Sensitivity............................... 11
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, f PnocmonK PLAN No. PPMN 4MoRK PLAN Tm.E: PAGE: 2 of11
. 1903.036 ADMINISTRATION OF POTASSIUM IODIDE REV: $
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_l.0 PURPOSE To provide guidance for the administration of Potassium Iodide (KI) to minimize uptake of radioiodines in the thyroid gland. I 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: ;
i 3.2.1 1903.033, " Protective Action Guidelines for Rescue / Repair !
and Dat.wge Control Teams" J
3.2.2 1903.065, " Emergency Response Facility - Technical Support O. Center (TSC) r 3.2.3 1903.067, " Emergency Response Facility - Emergency Operations Facility (EOF) i 3.3 REIATED ANO PROCEDURES:
1903.060, "Dmergency Supplies and Equipment" 3.4 REGULATORY CORRESPONDENCE CONTAINING NRC COMMITMENTS WHICH ARE IMPLEMENTED IN THIS PROCEDURE:
None 4.0 DEFINITIONS None 5.0 RESPONSIBILITY AND AUTHORITY 5.1 The Radiation Protection and Radwaste (RPERW) 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 inplementation of this procedure for off-site
/N emergency response personnel.
m PRocJwoRK PLAN NO. PROCEDURElWORK PLAN TITLE: PAGE: 3 of 11
. 1503.036 ADMINISTRATION OF POTASSIUM IODIDE Rm 6 CHANGE:
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- 5.3 The TSC Director is responsible for authorizing the administration of KI for on-site emergency response personnel. <
l 5.4 The EOF Director is responsible for authorizing the administration of l )!
- KI for offsite emergency response personnel. '
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6.0 INSTRUCTIONS l
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 I individual.
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 i advise them as to the need to issue KI in accordance with this procedure.
T 6.3 KI ISSUANCE REQUIREMENTS 6.3.1 When thyroid CDE is estimated to be 10 rem or greater.
l t 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.
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PROCJWOR PLAN NO. PROCEDURE / WORK PLAN TITLE: PAGE: 4 Of 11 l 1903.036 ADMIN 3TRATION OF POTASSIUM IODIDE REV: 6 i
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'6. 4 DISTRIBUTION OF KI :
i NOTE KI is stored in the following locations: I l A. TSC Emergency Kit i B. Onsite Radiological Monitoring Kit (located in the OSC) l C. EOF Emergency Kit l
D. Field. Monitoring Kits (located in the EOF) 1 6.4.1 Assemble the individuals who were designated to receive KI and the individuals to administer the KI.
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- 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.
l 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 NOTE The TSC Director / EOF Director can authorize the administration of KI in the field after the Field Monitoring Team members have complied with the guidelines of this procedure. Completion of the KI documentation may be accomplished later at the convenience of the TSC Director / EOF Director.
l 6.5.1 If possible, KI should be administered approximately one- i half hour before exposure for maximum blockage. j 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 rinimum of six (6) to a maximum of ten (10) consecutive days. One tablet is issued each day.
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PROCJWORK PLAN NO. PROCEDURENWORK PLAN TITLE: PAGE: 5 of 11 i
, 1903.036 ADMINISTRATION OF POTASSIUM IODIDE REV: $
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(~ In all cases where airborne contamination is anticipated, 6.5.5 the use of proper respiratory equipment shall be considered. I il 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 Attachment 7.5, ANO Medical Questionnaire: Iodine Sensitivity, will initially be considered to be iodine sensitive and must be treated as follows: 1 A. The individuals will be relocated or replaced to ,
eliminate or minimize the uptake of radiciodine 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 radiciodine exceeded 10 rem has been identified and administered KI, as appropriate. j 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. i
. PROCJWORK PLAN NO. PROCEDURE / WORK PLAN TITLE: PAGE: 6 of 11
, 1903.036 ADMINISTRATION OF POTASSIUM IODIDE REV: 6 CHANGE:
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 5
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. 1903 035 ADMINISTRATION OF POTASSIUM IODIDE REV: $
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b' ATTACHMENT 1 l
THYROID COMMITTED DOSE EQUIVALENT GRAPH ;
5$
I 1000 k
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1 1.00EM 1.00E4 1.00E 04 4.80E@
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M31 Concentration (ucilec)1 Protection Factor
PROCJWORK PLAN NO, PROCEDURE / WORK PLAN TITLE: PAGE: 8Of11
. 1903.035 ADMINISTRATION OF POTASSIUM IODIDE REV: 6 CHANGE.
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ATTACHMENT 2 POTASSIUM IODIDE PRECAUTION LEAFLET
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THYROIO BLOCl0NG AGENT INSTRUCTION SHEET -
i THYRO-BIDCK )
TAB!ETg in a redelion emergency, reecective lodine may be reisesed in the air. ;
(FOTASSIUM30DIDETAD!ITS USP) This metenal may be breathed or owellowed R may arder the thpo6d I giend and damage R. The damage would probotsy not show neelf for I (praumuved pos-TASS ense EYE olHeysd) years. l (abbrenesed. FJ) i If you take polmoshen ioede,Iwiu fln up your thyrood giend. Ties reduces j TAKE POTASSIUM IODIDE ONLY WHEN AUTilORIZED.
IN A RADIATION EMERCENCY. SLADIOACTIVE LODINE j COULD BE RELEASED INTO THE A!II. FUTABEtt!M WHO SHOULD NOT TAKE POTASSIUM IODIDE IODIDE (A FORM OF IODINE) CAN REIE PP,OTECT YOU. The any people who should not tehe posseenen imede are peop6e who know they are energsc to toece You may tehe poteeshan lades even if j j IF YOU ARE TOLD TO TAKE THIS htEDICINE. TAKE IT you are teiong muecines for e myrosa proldom (for esemple, e thyreld l 4
ONE TIME EVERY 24 HOURE. DO NOT TAKE IT MORE hormone or enulhpo6d drug). Prepard and nursing women moy also j MORE WIIL NOT HELF YOU AND MAY
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INCREASE THE RISK OF BRDE EFFECTS. DO NOT TAKE THIS DRUC IF YOU KNOW YOU ARE ALLERCIC TO HOW Af0 WHEN TO TAKE POTASSIUM IODIDE -
IODIDL (SRE SIDE EFFEcrs BERE%.) !
P be h a m se W W N You should tehe one does every 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br />. More we not help you boomune d
the thyroid can " hold" only hmmed amounts of loene. Larger donne udl increcee the nok of sede effects. You we probotWy be told not to tehe the
' drug for more than ten days.
IMMCATION5 j THfROlD ' 4LOCICNG IN A RADIATION EMERGENCY ONLY. SIDE EFFECTS j Usumily, side effects of poteesium lahde happen when people tehe higher j doses for a long time. You should be careful not to tehe more tien the DIRFCTIONS FOR USE recommetried does w take t for longer then you are told. 86de effects Use only as directed in the event of a radiation ernergency. are unlikey because of the low dose and the short time you wiu be teidng the drug.
. DOSE Totnets: One (1) tablet once a deY- Possitne side effects inclues skm reehes. ading of the sehery glands, and 'mestn* (metallic teste, buming mouth and throat, sore teeth and Take for 10 days unimes directed othenanne by the Emergency Director o' gums, symptome of a heed cold, and sometimes stomach Upest and Ortsite Emergency Coordmotor.
deerrhes).
Store et controned room temperature between tS* end 30'C (SP to 86* A few people have en ellergc reactson wth more serious symptoms.
F) Keep container tightly closed and protect from light. These could be fever and joint pains, or swelimg of parts of the fece end body and at bmee newsre shortnese of brooth regtenng immediate medicef WARNING anenten.
Potassrum mede shoukf not be used by people e0erge to inede. Keep out of the reach of chileen. In case of overdose or energic reactson, Teidng kMhde rney reroy cause overectMty of the thyroid giend, contact a phyaclan underectMty of the thyrood gland, or enlargement of the thyroid gland Dr.sCRirTION Esoi, THYRO-BLOCK TABLET cordelne 130 rng of poteeshan iodide wngy TO po sp Sg)E EFFECTS OCCUR
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Other Ingrennts: magnesium steerste, ,7=.a, cetulose, elkee N the sido eflects are esvere or d you have en energic reaction, stop toldng gel, modium inkaulfste.
poteesium toede. Then, if possible, cet e doctor or put$c health andhorty for metructions HOW SUPPLIED HOW POTASSIUM IODIDE WORKS THYRO-BLOCK TABLETS (Potesesum ioede Tab 6sts. USP) botties of Certeln forms of lodine help your tfiyroid gland work right Most people 14 tablete (NDC 0037 0472-20). Eacti whee, round, scored tablet get the edene they need from foode Ike larupM est or fleh. The thyroid cardene 130 mg potmeasum ioeds.
can *stors' or hold only e certeln amourt of notline.
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. , Pig's 9 cf 11 Potassium Iodide (KI) Administration Form
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Name of Exposed Individual: , ,
Last First Middle I Social Security Number: Badge Number:
Duration of Exposure: I-131 Concentration:
Minutes Ci/cc in air i
Estimated Thyroid Dose Commitment: (Check One) 0 <10 Rem O 2 10 Rem !
Date of Exposure:
Respiratory Protection Worn During Exposure: (Check One) O Yes 0 No Respirator Protection Factor:
Known Iodide Allergy / Previous Allergic Reaction: (Check One) O Yes 0 No CAUTION I If the above box is checked yes, then do not administer KI.
I Verify that I have read and understand the precaution leaflet and I understand that taking thyroid blocking agent (KI) is strictly voluntary.
I (Check One) U Do O Do Not choose to take KI. I i
i Signature of Exposed Individual Date Approved:
EOF Director /TSC Director Date KI Tablets Issued By:
Signature Date Notes:
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FORM TITLE: FORM NO. REV.
POTASSUIM IODIDE ADMINISTRATION 1903.035A 6
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O FORM TITLE: FORM NO. REV.
Kl ISSUE RECORD 1903.036B 6
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. ',. Page 11 of 11 I MEDICAL QUESTIONAIRE: IODINE SENSITIVITY r'N .
Name: , , SS No:
LAST FIRST MIDDLE yl Badge Number: Company: Dept: ;
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Please answer the below listed questions and mark the appropriate box.
l NO. QUESTION YES NO s
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- 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? .
n 4. Have you ever had a gallbladder dye test, kidney x-ray (d requiring dye injection, thyroid isotope scan? If so, any reactions?
z Please explain any yes answers:
Signature: Date:
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FORM TITLE: FORM NO. REV.
ANO MEDICAL QUESTIONNAIRE-LODINE SENSITIVITY 1903.035C 6
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