Feasibility and Nurse Acceptability of Dexmedetomidine Use During I-131 MIBG Therapy in Pediatric Patients With Neuroblastoma

Abstract

Background

I-131 metaiodobenzylguanidine (MIBG) therapy effectively treats high-risk neuroblastoma but exposes caregivers and healthcare providers to radiation risks. Managing patient anxiety and agitation is essential for safety. Dexmedetomidine has shown potential as an anxiolytic, but its feasibility and acceptability in this setting are underexplored. This quality improvement (QI) project aimed to evaluate the feasibility and nurse acceptability of dexmedetomidine anxiolysis in our patient population.

Method

A retrospective chart review was conducted for pediatric patients who received dexmedetomidine during MIBG therapy between January and June 2023. Feasibility was assessed through adverse events, vital sign changes, and dose adjustments. Nurse acceptability was evaluated using a questionnaire adapted from the Theoretical Framework of Acceptability and a follow-up focus group.

Results

Seven patients received the full MIBG dose with dexmedetomidine and experienced no adverse events. Minor, transient vital sign changes were noted, and all patients adhered to radiation safety protocols. Ten nurses completed the acceptability questionnaire; 100% reported that dexmedetomidine was easy to administer, promoted patient safety, and supported safe MIBG administration. Ninety percent found dexmedetomidine to be an acceptable anxiolytic. Focus group participants (n = 3) identified themes surrounding intravenous access challenges and the need for improved interdisciplinary communication.

Discussion

Dexmedetomidine appeared to be a feasible and acceptable anxiolytic for pediatric patients receiving MIBG therapy in this small, single-unit QI project. Practice changes included a preadmission multidisciplinary huddle, interdisciplinary huddle requests for clinical concerns, and a dexmedetomidine administration standard operating procedure. This project underscores the importance of multidisciplinary collaboration and nurse feedback in refining clinical practice.