A model for in situ plan of care for a critically unstable pediatric patient following I‐131 MIBG infusion

Abstract

Recent clinical trials have moved iodine-131 (I-131) metaiodobenzylguanidine (MIBG) therapy into frontline management of high-risk neuroblastoma. With this expansion, it is reasonable to anticipate the need for intensive care level resuscitations. Radiation exposure remains the greatest risk to health care professionals managing these patients. We combined shock simulation scenario data with actual radiation dosimetry data to create a care model allowing for aggressive, prolonged in situ resuscitation of a critically ill pediatric patient after I-131 MIBG administration. This model will maintain a critical care provider's radiation level below 10% of the annual occupational dose limit (5 mSv, 500 mrem) per patient managed.

Impact of shield location on staff and caregiver dose rates for I-131 radiopharmaceutical therapy patients

“…Several published works have described very high I-131 dose rates and associated safety precautions. According to Flori et al [28], the highest dose rate is at the bedside and in front of the lead shield. Estimates indicate that a team member can remain in front of the lead shield for the first five hours after infusion, the most significant radiation exposure time, before reaching 5 mSv (500 mrem).…”

Nurses’ Experiences Caring for Children With Neuroblastoma Receiving 131I-Metaiodobenzylguanidine Therapy: A Qualitative Descriptive Study

“…Metaiodobenzylguanidine (MIBG), a drug that is an analog to nor-epinephrine and uptakes to neuroendocrine cells, provides targeted radiation therapy to the neuroblastoma cells when attached to high-dose radioactive iodine ( 131 I) (Agrawal et al, 2018). To limit radiation exposure to others following 131 I-MIBG infusion, children are required to be isolated for 3 to 7 days, preferably in lead-lined rooms, until local radiation restriction requirements are met (Agrawal et al, 2018; DuBois et al, 2015; Flori et al, 2020). Due to the cumulative risk of radiation exposure for healthcare workers, 131 I-MIBG therapy programs rely on family presence in the hospital (Sharp et al, 2016).…”