MIBG Therapy: Caring for Your Child in the Hospital

Your care team will teach you how to care for your child during their hospital stay for I-131 MIBG therapy. 

Patients who get I-131 MIBG therapy at St. Jude usually stay in the hospital for 3 or more days. An adult caregiver must stay at the hospital at all times. More than 1 caregiver can be on the caregiver list. Only 1 caregiver can stay overnight. The MIBG therapy suite has a parent room for adult caregivers. No visitors are allowed other than approved caregivers. Pregnant caregivers are not allowed because of the risk to the unborn baby.

What is MIBG therapy?

MIBG stands for metaiodobenzylguanidine. It is a liquid absorbed by neuroendocrine tumor cells. MIBG is combined with radioactive iodine (I-131) which kills cancer cells.

This treatment involves radioactive materials. St. Jude has special guidelines and protections to keep patients and families safe. Talk to your care team about what to expect before, during, and after I-131 MIBG therapy.

St. Jude MIBG therapy suite

The MIBG therapy suite is on the 2^nd floor of the Bone Marrow Transplant Unit.

The MIBG suite has 3 separate areas:

• Patient/treatment room (radiation isolation room)
• Anteroom (entry room)
• Parent room

These rooms are designed for safety and comfort during and after MIBG therapy.

Patient/treatment room (Radiation isolation room)

The room where your child will stay and get the MIBG treatment has lead-lined concrete walls and radiation monitors. Your child will have their own bathroom.

The St. Jude Radiation Safety Division gets the room ready before you arrive.  Your child’s bed or crib will have radiation shields placed around it. The floor, bathroom, and other hard surfaces will be wrapped in absorbent paper or plastic.

The patient room will have an intercom system for communication as well as a television, game system, and other entertainment features.

Anteroom (entry room)

This space is an entry area before the patient/treatment room. It is stocked with special supplies for MIBG therapy. Parents and staff will use this area to get ready to enter the patient room. 

Anyone entering the patient/treatment room MUST wear: 

• Personal protective equipment (PPE): Gown, gloves, face mask, and shoe covers. A face shield should be worn when handling liquids that might splash.
• Radiation measurement device (dosimeter): This is worn under PPE to measure radiation levels.

Before your child’s therapy begins, your care team will teach you how to use these items correctly.

Parent room 

The parent room is for adult family caregivers who are staying with the patient. It is next to the patient room and has a bed, bathroom, storage, and TV. 

The parent room includes a leaded glass window that looks into the patient room so you can see your child. An intercom system allows you to talk with them.

What to expect during MIBG therapy

A nuclear medicine technologist will bring the infusion cart to your child’s room. 

When your child’s medicine is ready, radiation isolation precautions start. This means that anyone present must wear PPE and a dosimeter. Only essential medical staff should enter the patient/treatment room during the infusion. 

The nuclear medicine technologist will give your child’s MIBG treatment through your child’s central line or through an IV inserted into a vein. The infusion takes 1.5-2 hours.  

After the infusion, the nuclear medicine technologist will remove the infusion cart from the room.  

Care for your child after MIBG therapy

For a few days after treatment, physical contact with your child is limited. This is to protect others from radiation. Everybody who enters the patient room must wear personal protective equipment to protect themselves from radiation exposure.

Your child must stay in the patient/treatment room at all times during their hospital stay. This is important to prevent radiation from spreading to other areas. Any items that go into the patient room must stay inside unless cleared by the Radiation Safety Division. 

Because nurses are frequently exposed to radiation, the nurses’ contact with your child is limited to complex medical care, such as giving IV medicines.

Family caregivers play an important role in caring for patients during their hospital stay after MIBG therapy. You will be expected to provide the following routine care for your child:

• Help brush teeth and assist with any other personal care needs
• Use bath wipes for bathing
• Change clothing and bed linens if they are dirty or soiled
• Help feed your child snacks and meals
• Make sure your child drinks plenty of fluids
• Give medicines by mouth or feeding tube
• Help your child use a bedside commode or bedpan, and empty the bedpan 
• Change diapers or help with toileting

How to minimize radiation exposure

After the infusion, most of the excess radioactive iodine will leave the body through urine (pee). Your child will pee through a urinary catheter placed before treatment begins. It will go into a bag and be pumped down a drain near your child’s bed. Radioactive iodine is found in other bodily fluids such as vomit, poop, blood, sweat, saliva (spit), and oils on the skin. 

Take these steps to minimize your exposure to radiation:

• Limit time spent in the patient room.
• Try to keep at least 6 feet away from your child.
• Stay behind the lead shielding around your child’s bed as much as possible.
• Avoid physical contact with your child when possible.
• Do not eat inside the patient room. Do not take personal food or drink items into the patient room. 
• Do not use the bathroom inside the patient room. Only use the restroom in the parent room.
• Do not sleep in the patient room.
• Do not take any personal items into the patient room. This includes items such as phones, laptops, and books. 

How to prevent possible contamination

Follow these steps to prevent possible radiation contamination:

• Try not to touch your child or anything in the patient/treatment room that may have come in contact with your child. 
• Wear gloves and protective clothing to lower your personal contamination. The care team will teach you how to remove these items and throw them away as you leave the room.
• Do not take anything out of the room. The Radiation Safety Division will dispose of all trash and must clear any item before it leaves the patient/treatment room.

Radiation exposure monitoring 

You will wear a radiation dosimeter to monitor your radiation exposure. You will track the amount of radiation you are exposed to every time you enter and exit your child’s treatment room. Radiation Safety Division staff will show you how to use this device and record your radiation exposure.  

Discharge after MIBG therapy

Your care team will determine when it is time for your child to be discharged from the hospital. This will be based on your child’s health status and radiation levels. Your care team will provide you with specific safety instructions to keep your child and others safe from radiation exposure after leaving the hospital.

Who can I contact for further information?

Contact your primary clinic if you have questions about your child’s treatment.

For questions about radiation safety or policies, contact the St. Jude Radiation Safety Division at 901-595-5497.