NOCSPEN Newsletter: April 2019
April 8-12, 2019
UVA Nutrition Support Trainee Ship 5 Day
April 9, 2019
Free Webinar: Goal Directed Nutrition Therapy in Critical Illness
April 17, 2019
Free Webinar: How to Write a TPN Order
April 24, 2019
An Overview of the Two Newest Lipids Available in the US: SMOFLIPIDS & OMEGAVEN
May 11, 2019
Oley Foundation Regional Conference
May 15, 2019
Free Webinar: Pediatric SBS
May 15, 2019
FODMAPs and IBS Workshop: Beyond the Basics
June 21, 2019
Oley Annual Conference
June 19, 2019
Free Webinar: Nuts and Bolts of EN
To view a full list of our events, click here.
NOCSPEN does not endorse any external programs, training, products, or services.
Did you know ASPEN has many great resources for studying for the CNSC exam? The Self-Assessment Program is one option; it's an online module with test questions to assess your level of knowledge. This is a great resource for determining where to focus your studying and it offers practice questions.
Review Summary: Branched-Chain Amino Acids
Branched Chain Amino Acids
— By Dan Furtado, Pharm.D.
An article by PJ White & CB Newgard, published in Science, 8 Feb 19, describes how the three branched-chain amino acids (BCAAs), leucine, isoleucine, and valine, can either serve as a biomarker or possibly a causal agent, or both in cardiometabolic disease. While branched-chain amino acids are important in both protein synthesis and as anabolic agents, their increase in obesity-associated conditions, such as insulin-resistance, type 2 diabetes, and cardiovascular disease corelates with rising insulin levels, associated with insulin resistance. In addition, there is a corresponding increase in circulating aromatic amino acids, phenylalanine and tyrosine, and a decrease in glycine levels. Individuals who subsequently lost weight or underwent gastric bypass surgery had a noted decline in circulating BCAAs, and, consequently, a better improvement in glucose homeostasis.
Obesity and increased levels of BCAAs, result in a decrease in BCAA oxidation in adipose tissue due to suppression of all BCAA catabolic enzymes and from increased phosphorylation and inactivation of branched-chain ketoacid dehydrogenase complex in the liver. Genetic variants that are associated with dyslipidemia and insulin resistance are strongly associated with an increase in circulating BCAAs, and an increased risk of type 2 diabetes. BCAAs are clearly a biomarker of cardiometabolic disease phenotypes.
Article: Bolee Bag
Innovation in Enteral Nutrition Delivery
— By Cynthia Reddick, RD, CNSC
National Tube Feeding Manager
Coram/CVS Specialty Infusion
Innovation is defined by Webster as 1) the introduction of something new and 2) a new idea, method, or device. Innovation in the space of enteral nutrition, until recently, has been mostly limited to alterations and refinements in formula composition. Most of the significant advances in enteral nutrition delivery methods occurred in the 20th century beginning with post-pyloric tube placement in 1910 then continuous and controlled infusion of liquid nutrition in 1916. The evolution of controlled feeding via a pump began in 1930, continued in the 1950’s and were more widely used in hospitalized patients in the 1970’s. The accuracy and safety of feeding pumps has evolved further in the 1990’s and beyond. Innovation in enteral feeding methods has mostly been limited to advancements with enteral feeding pumps with bolus and gravity feeding methods remaining the same throughout this time frame. The introduction of the Bolee Bag and Bolink sets in 2018 add a 4th feeding method available to tube fed individuals and contributes to tube feeding innovation in the 21st century. Tube fed patients not using a pump, especially those that tolerate bolus or syringe feedings may benefit from this option, particularly in the home setting, as it allows for larger feedings for those that tolerate more volume at once and provides an option for those who struggle to manipulate syringes due to hand strength or dexterity issues. This innovation also normalizes tube feeding by allowing store bought commercially packaged pureed food to be administered with a simple connection. Additional information on this feeding method is below:
BoleeTM Bag and BolinkTM Large Cap
BolinkTM Small Cap
Images provided by U Deliver Medical, LLC.
375 ml (12.5 oz) bag size
The bFed System contains 3 items: Bolee Bag, Bolink Large Cap and the Bolink Small Cap.
For use in homecare, a sample monthly supply kit could include 10 Bolee Bags + 10 Large Cap Bolink + 2 Small Cap Bolink
ENFit connection. Legacy tubes require a legacy to EnFit adapter.
Individuals with buttons and legacy extension sets can convert to ENFit extension sets in lieu of adapter
Homecare orders should specify gravity method of administration (HCPC B4036 or S9341) for billing purposes
Watch this video for a clear understanding of the product and how it works.
Sample kits can be requested by emailing firstname.lastname@example.org
Benefits of Use:
Gravity or squeeze/bolus method
Works with blenderized tube feeding (BTF) and standard formula
Holds larger volume of formula: 12.5 oz bag
Easy to clean
Convenient and easy to use and may decrease or eliminate spills or mess with bolus feeding
Potential Disadvantages of Use:
Lack of familiarity by prescribers
Limited control of rate
Not indicated for jejunal feeding
Availability via infusion provider or DME provider
Thicker blends (BTF) require diluting with 40-60 mL of water for ease of use
If patient has a legacy tube connection, a reverse adapter is required to connect to a Bolink set.
Harkness, L. The History of Enteral Nutrition Therapy: From Raw Eggs and Nasal Tubes to Purified Amino Acids and Early Postoperative Jejunal Delivery. J Am Diet Assoc. 2002;102:399-404.
Chernoff, R. An overview of tube feeding: From ancient times to the future. Nutr Clin Pract. 2006 Aug;21(4):408-10.
Gorman RC, Nance ML, Morris JB. Enteral feeding techniques. In: Torosian MH, editor. Nutrition for the Hospitalized Patient: Basic Science and Principles of Practice. New York, NY: Marcel Dekker Inc; 1995. pp. 329–35.
Latest In the News
Pediatric Feeding Disorder - Consensus Definition and Conceptual Framework
Pediatric feeding disorders lack a universally accepted definition, and previous diagnostic paradigms have defined “feeding disorder” from the perspective of a single medical discipline. Dr. Praveen Goday and colleagues have just published apaper in the Journal of Pediatric Gastroenterology and Nutrition proposing diagnostic criteria for pediatric feeding disorders.
The NOVEL (New Opportunities for Verification of Enteral Tube Location) Project was launched to address an important issue—what is the best practice to verify nasogastric (NG) feeding tube location in pediatrics? NG tube misplacement can cause serious harm and/or death to patients. X-rays can be used to verify proper tube placement, but with pediatric patients, NG tubes can be removed several times a day. The use of x-rays to verify every tube placement can overexpose these patients to radiation. Click here to read more about the project.
Recently Published Article on Peri-operative Nutrition
In the peri‐operative period, the primary nutrition goals are to evaluate the patient for pre‐existing malnutrition, treat malnutrition to optimize surgical readiness, minimize starvation, prevent post-operative malnutrition, and support anabolism for recovery. See the article by Drs. C. Gillis and P. E. Wischmeyer in Anaesthesia 2019 on this timely topic.
Have an interesting article or news to share? Please send it to us at
Erin Lavin, RD, CNSC
I have been an RD for 6 years specializing in critical care with my last 3 years at UC Davis Medical Center as the Neuro ICU and Neuroscience step-down unit dietitian. I also had a stint as the TeleNutrition Clinic RD at UCD as well. I recently presented two posters at the Neurocritical Care Society's Annual Meeting this past September in Florida: one on implementing Bowel Care Guidelines in a Neuro ICU, and the other comparing predictive equations for energy needs of TBI patients. I was the only dietitian at the conference, but I'm hoping to change that in the years to come. I also spoke at FNCE this past year as a part of an expert panel speaking on "Advancing Your Practice Through Telehealth". To me, NOCSPEN is an opportunity to bring great minds together to advance our profession and improve patient care on a much bigger level. On the side, I'm training for my first bodybuilding competition inApril. Wish me luck!
Sofia Moon, RD
I was born in Korea and raised in Mexico City. After moving to the States for college, the values and attitudes towards different cultural foods stemmed my fascination in nutrition and health. I graduated from UC Berkeley with a B.S. in Nutritional Sciences & Dietetics, completed my dietetic internship at UCSF Medical Center, and have been working as a clinical dietitian at UCSF ever since. I am excited to be a part ofNOCSPEN as the Communications Chair because I have the chance to create an online platform where health professionals can connect, obtain resources, and collaborate as a community. With graphic design as one of my hobbies, I hope to use design to craft thoughtful solutions and effectively deliver nutrition information. In my spare time, I also like to paint, eat sushi, and take care of my house plants.
Get Involved with NOCSPEN
If you have general inquiries, questions or feedback for our chapter, or you would like to join the board or attend a board meeting, please let us know at NOCSPENchapter@gmail.com.
This year, we are looking for Student Coordinators / Representatives from Dietetic Internships/ Universities (1 year term).
In This Issue
Article - Review Summary
Article - Bolee Bags
Latest in the News
Get Involved with NOCSPEN
Do you know an individual that you wish to spotlight their achievements? We will spotlight two individuals each newsletter. Contact us if you know of an individual, whether it is a dietitian, a nurse, a pharmacist or a physician.
For now, we are going to spotlight our NOCSPEN Board Members!