Critical Care Nutrition: Adults and Pediatrics

Apr 18, 2018 5:00pm ‐ Apr 18, 2018 6:30pm

Credits: None available.

Since the publication of the 2016 American Society of Parenteral and Enteral Nutrition and Society of Critical Care Medicine's Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient, numerous randomized controlled trials have challenged the recommendation for early enteral nutrition, suggesting early exclusive parenteral nutrition is safe, feasible, and associated with equal outcomes. New data has also challenged the recommendation for supplemental parenteral nutrition in the critically ill adult and will be discussed thoroughly in this webinar. Additionally, ther will be an evaluation of the 2017 ASPEN Comprehensive Nutritional Guidelines for Critically Ill Pediatric Patients and their application to patients in the inpatient and outpatient clinical settings. Highlights include laboratory monitoring parameters for long-term parenteral nutrition, ideal additives and supplementation to parenteral nutrition and recommendations to reduce the incidence of central-line associated blood stream infections.

Learning Objectives:

• Describe guideline recommendations for use of exclusive and supplemental parenteral nutrition in the critically ill adult.
• Identify and appraise landmark randomized controlled trials comparing early enteral versus early exclusive parenteral nutrition in critically ill adults.
• Identify and appraise landmark randomized controlled trials comparing early enteral plus supplemental parenteral nutrition to enteral nutrition alone.
• Cogitate on scenarios for exclusive and supplemental parenteral nutrition.
• Describe long-term parenteral nutrition lab monitoring in the inpatient and outpatient settings

Nutrition Assessment: Nutrition Focused Physical Exam

May 10, 2018 2:00pm ‐ May 10, 2018 3:30pm

Credits: None available.

Please note that recording of the presentation given by Elizabeth Gallant, RD, LD, CNSC is not included at the speaker’s request.

This webinar will provide an overview of the Nutrition Focused Physical Exam (NFPE) for both the adult and pediatric patient populations. The speakers will discuss characteristics of malnutrition such as muscle wasting, fat loss, edema and micronutrient abnormalities and how to identify them. They will provide examples of how they have incorporated NFPE into their current practice and how they have overcome the barriers to get to this point. They will examine case studies to put the entire NFPE to use and review coding for malnutrition.

Learning Objectives:

• Summarize the use of nutrition focused physical exam in identifying malnutrition in both pediatric and adult patients
  
• Identify clinical signs of malnutrition, includin muscle wasting, fat loss, edema and micronutrient abnormalities
  
• Determine how to incorporate the nutrition focused physical exam into practice

Promoting Safety of the PN Use Process Through Nutrition Support Competencies

Jun 7, 2018 2:00pm ‐ Jun 7, 2018 3:30pm

Credits: None available.

Parenteral nutrition (PN) is a high alert medication that is commonly used in the hospital and home care settings and is a life-sustaining therapy for patients who cannot meet their nutrition and hydration needs by oral or enteral means or have contraindications to enteral therapy. The PN use process (ordering, order review, compounding, and administration) is associated with risk, however the use of evidence based protocols for PN management focus on minimizing PN related errors and have demonstrated that PN can be safely used in appropriate patients. Safe and effective use of PN requires input from skilled clinicians of multiple disciplines. Ensuring the competency of all team members is essential to promoting safe practices and maximizing clinical outcomes throughout the PN use process. This webinar will focus on strategies for ensuring competency in PN ordering, order review and verification, compounding, and administration to patients. It will also discuss methods of evaluating the competency of clinicians involved in providing PN within an institution.

Learning Objectives:

• Identify procedures for PN ordering, order verification, compounding, and administration that promote safe PN practices.
• Describe risk mitigation strategies for PN ordering, order verification, compounding, and administration
  
• Construct a method to assess and maintain competency for clinicians involved in providing PN
  

Enteral Nutrition Access and Medication Administration

Jul 13, 2018 2:00pm ‐ Jul 13, 2018 3:30pm

Credits: None available.

This webinar will explore enteral nutrition (EN) access and caring for enteral feeding tubes. The first part of the webinar will include education on the identification of medications that are incompatible with or may have potential negative interactions with EN that warrants the holding of EN. Concerns regarding the pharmacokinetics of different forms of medication and the use of pharmacologic agents to unclog feeding tubes will also be discussed. The second part of the webinar will focus on the different types of commonly placed enteral feeding tubes and considerations on the choice of formula and infusion rate to prevent complications. Both sessions will focus on practical tips using case-based scenarios and up-to-date research studies.

Learning Objectives:

• Assess three risk issues for medications which will present difficulties when administered via feeding tube.
• Evaluate a feeding tube clog using the recommended procedures and processes and select remedies to restore flow.
• Recognize and differentiate between types of enteral access and the key components of each

Malnutrition, Protein, and the Role of Early Enteral Nutrition: What's New Since the 2016 ASPEN/SCCM Guidelines

Aug 1, 2018 4:00pm ‐ Aug 1, 2018 5:30pm

Credits: None available.

Protein is a vital macronutrient for critically ill patients yet the optimal amount and its relationship to outcomes is not completely clear. New research on protein needs and the role of early enteral nutrition has been published since the 2016 ASPEN/SCCM guidelines were released. This webinar will review the protein dosing and early EN outlined in the ASPEN/SCCM guidelines and discuss the new literature on protein dosing and the role of early enteral nutrition. The speakers will also address if/how this research has impacted practice for enteral nutrition in the critically ill patient.

Learning Objectives:

• Outline the ASPEN/SCCM guidelines for protein dosing and early enteral nutrition.
• Review the new literature that has impacted practice since the development of the 2016 ASPEN/SCCM guidelines.
• Translate recent research to evidence based practice for protein dosing in the critically ill patient.
• Describe the rationale for current early enteral feeding of the critically ill patient based on recent literature.

PN and Home PN

Aug 16, 2018 2:00pm ‐ Aug 16, 2018 3:30pm

Credits: None available.

ASPEN’s Nutrition Support Fundamentals Course (NSFC) provides a comprehensive overview of nutrition support therapy. The course can be used as a tool for helping you identify personal knowledge gaps to further identify future areas of learning. Whether you are preparing for the certification examinations or seeking additional professional growth in nutrition support, recognizing these knowledge gaps allows you to use your professional development time and energy more effectively. In addition to providing a thorough review of core nutrition support topics such as nutrition assessment and nutrient deficiencies, parenteral nutrition, enteral nutrition, fluids and electrolytes, and pediatrics, the NSFC will also include specialty areas of nutrition support such as home care, critical care, gastrointestinal disorders, ethics, and statistics. Don’t miss this invaluable nutrition support-focused course!

Objectives:

• Identify current indications for parenteral nutrition 
• Discuss parenteral formula design
• Evaluate components of parenteral nutrition monitoring and management
• Identify key safe practice issues
  

Use of Alternative Lipid Injectable Emulsions: A Whole New World of Products

Aug 21, 2018 3:00pm ‐ Aug 21, 2018 4:30pm

Credits: None available.

Lipid injectable emulsions (ILEs) are a dense source of calories and are a source of the essential fatty acids (EFAs), important for cell membrane development and precursors to key modulators involved in cellular pathways of the immune response. In the early 1970s, the ILE approved for use in the United States was a solely soybean oil-based fat emulsion (SOFE) and until recently was the only FDA approved product available in the US market. While very little has changed in the provision of ILEs over the last four decades in the United States, multiple products have come to market in other areas of the world such as Latin America, each with the intent of being an ideal oil source. With the recent approval of newer ILEs in the US market, opportunities for expanded use of alternative lipid sources have been possible. This webinar will include a discussion of the use of recently FDA approved ILE products, particularly the mixed-oil based fat emulsion (MOFE) with practical tips from those with experience using the products.

Learning Objectives:

• Compare and contrast the various lipid injectable emulsions currently available
• Describe the benefits and challenges in using the newer lipid injectable emulsions
• Determine the appropriate use of newer alternative lipid injectable emulsions in neonatal, pediatric, and adult populations

The Gut Microbiome - Taking a Nutrition Approach to Modify Disease

Oct 10, 2018 2:00pm ‐ Oct 10, 2018 3:30pm

Credits: None available.

The microbiome is an important modulator and contributor to presence of disease as well as severity and recovery. Nutrient intake can affect the microbiome. In this webinar, the speakers will provide advanced information for clinicians in the evolving world of the microbiome. This webinar is targeted at an advanced level and builds upon webinars that were offered in 2016 and 2017. Recordings of those webinars are available in ASPEN’s eLearning Center and can provide a foundation of knowledge prior to this webinar. Modifying the Gut Microbiota: Clinical Applications and Current Evidence and Microbiome: Research Update and Cutting Edge Applications

Learning Objectives:

• Summarize the effects of antibiotics on gut microbiota, its metabolic byproducts, and intestinal health
• Define targeted efforts to maintain gut health and mitigate intestinal pathogenic bacteria colonization induced by antibiotic therapy as well as SIBO
• Describe whether gut microbiome composition predicts low FODMAP diet efficacy in irritable bowel syndrome (IBS)
• Determine whether a low FODMAP diet alters gut microbiome composition and/or metabolite profiles in those with IBS

Cancer and the Ketogenic Diet

Nov 7, 2018 3:00pm ‐ Nov 7, 2018 4:30pm

Credits: None available.

Many individuals diagnosed with cancer seek to modify their diet as an adjunct to their treatment. One new diet that has gained popularity in some oncology patient populations is the ketogenic diet. This program will provide a thorough review of the literature and evidence on the beneficial effects of ketogenic diet in oncology. Information will be provided on the nutritional goals of the various therapeutic ketogenic diets for oncology patients as well as the implementation and management of the ketogenic diet.

Learning Objectives:

• Summarize the present literature supporting the ketogenic diet in different cancer types
• Outline the benefits and risks involved with ketogenic diet in different cancer types
• Initiate and manage a therapeutic ketogenic diet for oncology patients

PN Shortages and Use of Multi-Chamber Bag PN Products

Dec 11, 2018 2:30pm ‐ Dec 11, 2018 4:00pm

Credits: None available.

Parenteral nutrition component shortages are frequent and concerning to the nutrition support practitioner given the limited availability of therapeutic alternatives. Fortunately, during the last decade, several standardized commercially-available parenteral nutrition (MCB-PN) products have entered the market. This presentation will cover the types of products available for use in the United States and the evidence regarding use of these products and patient populations to consider during shortages. The presentation will also describe the experience of operationalizing MCB-PN in a rapid manner in a large, academic institution, highlighting “things to remember” when implementing use of these products with prescribing and electronic prescribing. The faculty will take a practical approach to presenting this information through the utilization of case presentations.

Learning Objectives:

• List the types of MCB-PN available on the U.S. market.
• Summarize evidence associated with MCB-PN.
• Identify the challenges associated with implementing MCB-PN in an institution. 
• Discover safe practices for prescribing, dispensing and administration.