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Nutrition Support

Diseases of the gastrointestinal tract often lead to the development of malnutrition. When the body does not receive needed nutrients because of faulty absorption, severe GI disease, or chronic poor nutrient intakes, specialized nutrition support can be administered via alternative methods other than food itself. This specialized nutrition support is also referred to as enteral or parenteral nutrition.

Enteral Nutrition: Many medical conditions can cause a person to lose their appetite or their ability to ingest food for an extended period of time. Someone who is unable to eat and drink, but has a functional gastrointestinal tract, may benefit from specialized nutrition support called enteral nutrition or tube feedings. This type of feeding can be administered through a small, flexible tube placed into the nose and ending in the stomach or small intestine. For longer-term feeding, a more permanent tube can be placed directly into the stomach or small intestine. Once the device is placed, a specialized formula is infused to provide well-balanced nutrition.

Parenteral Nutrition: A diseased gastrointestinal tract may not allow food or tube feeds to be digested and absorbed adequately to sustain his or her nutritional state of health. Instead of using the digestive tract to meet a person’s nutrition needs, a highly specialized form of nutrition support known as parenteral nutrition may be required. Parenteral refers to the delivery of a drug, fluid or, in this case, a nutrition solution into the blood stream through a vein. This is done by placing a catheter into a vein. Parenteral nutrition may be used on a short-term basis to facilitate postoperative healing or long-term in patients with permanent or severe malabsorption.

At Cleveland Clinic, nutrition support expertise is provided by various teams including the Nutrition Support Team, Home Nutrition Support Service, infusion and enteral access nurses, and home enteral nutrition dietitians.

Cleveland Clinic's Nutrition Support Team, established in 1975, is the largest multidisciplinary nutrition support team in the nation and is internationally recognized as a leader in the field of specialized nutrition support. The team consists of dietitians, nurses, a pharmacist, case managers, social work, physician assistants, fellows, and staff physicians who work collaboratively to implement the most current evidence-based practices in regards to catheter care, enteral tube placement, and management of parenteral nutrition infusions.

Medical conditions affecting the function of the gastrointestinal tract sometimes make it impossible to obtain proper nourishment by the usual process of eating and digestion. This can happen in cases of severe Crohn's disease, bowel obstruction, short bowel syndrome, intestinal ischemia, radiation enteritis, or high output fistulas. Often, the only feasible option for patients to get sustenance is by using parenteral nutrition (PN), where a solution of vitamins, minerals, proteins, fats, and carbohydrates is infused into a vein through a catheter. PN may only be needed for short periods of time, other times, PN may be required for months or years. In that case, the Nutrition Support Team clinicians work together with the Home Parenteral Nutrition team to safely transition patients home with PN.

Some individuals have difficulty digesting nutrients in their upper GI tracts, but their lower GI tracts function very well. In these cases, the enteral access nurses use a portable, electromagnetic device to place a feeding tube that goes beyond the stomach and into the small bowel. Nurses, who are specially trained in this bed-side technique, are able to facilitate early enteral nutrition, which is well-known to promote healing and decrease the length of time spent in the hospital.

Department Contact Info
9500 Euclid Ave. TT2
Cleveland, OH 44195
216.444.5957

History of the Nutrition Support Team at Cleveland Clinic

The modern day era of parenteral nutrition began in 1937, when the Journal of The American Medical Association article reported peripheral intravenous (IV) feeding in humans using carbohydrates and protein hydrolysates. Unfortunately, the use of this therapy was limited because of the inability to provide adequate amounts of nutrients through hand and arm IV sites for prolonged periods of time.

Over the next 2 decades in Philadelphia, Dr. Harry Vars, Dr. Jonathan Rhoads, and eventually, Dr. Stanley Dudrick worked to perfect the technique of IV feedings in dogs and humans. Dr. Dudrick was ultimately successful in showing that normal growth and development could be achieved in beagle puppies. Dr. Wilmore later joined Dr. Dudrick and used IV nutrition for infants who were born with catastrophic gastrointestinal conditions and adults with pre and post-operative gastrointestinal dysfunction.

In the late 1960s, the use of intravenous feeding became popular in many hospitals throughout the country. As time went on, this gastrointestinal tract function replacement therapy was adapted for use in patients with inflammatory bowel disease and gastrointestinal dysfunction after major surgery in the early 1970’s at Cleveland Clinic.

In 1975, Dr. Ezra Steiger, a General Surgeon and member of the original Philadelphia research group, was recruited to Cleveland Clinic to organize a formal Nutrition Support Team with multidisciplinary expertise in nutrition, vascular access, and nutrient pharmacology. The small group, initially including only a physician and a nurse, quickly expanded to employ the expertise of a pharmacist and dietitian.

Protocols and guidelines were gradually developed and established to safely support a patient’s nutritional needs intravenously when their intestinal tract did not function. As the importance of restoring and maintaining a patient’s nutrition while in the hospital became accepted, the Nutrition Support Team became busier and grew larger. It also soon became apparent that there were a group of patients with permanent gastrointestinal dysfunction (because of issues like short bowel syndrome) that would need prolonged, and sometimes indefinite, IV nutrition once they were discharged from the hospital. In 1976, this led to the development of Cleveland Clinic’s Home Parenteral Nutrition Team.

Ezra Steiger MD, FACS , FASPEN

Meet Our Clinicians
Robert DeChicco, MS, RD, LD, CNSC

Title: Nutrition Support Team Manager, Nutrition Education Coordinator, Clinical Nutrition Fellowship Program Coordinator
Education: MS Nutrition, Case Western Reserve University, Cleveland, Ohio; B.S. Nutrition, Case Western Reserve University, Cleveland, Ohio; A.A.S. Dietetics, Youngstown State University, Youngstown, Ohio; Dietetic Internship: University Hospitals, Cleveland, Ohio
Specialty Areas: Nutrition Assessment, Parenteral Nutrition, Nutrition Education
Other: Member of Academy of Nutrition and Dietetics; Member Dietitians in Nutrition Support Group; Member of American Society of Enteral and Parenteral Nutrition; Member of Ohio Society of Parenteral and Enteral Nutrition

Kathy Logan Coughlin, MS, RD, LD, CNSC

Title: Nutrition Support Clinician
Education: MS Clinical Nutrition, Rush University, Chicago, Illinois; B.S. Dietetics, University of Dayton, Ohio; Dietetic Internship: Rush University, Chicago, Illinois; Fellowship: Rush Presbyterian – St. Lukes Medical Center, Chicago, Illinois
Specialty Areas: Nutrition Support, Nutrition-focused Physical Exam
Other: Associate Editor of Support Line, Member of Academy of Nutrition and Dietetics; Member of Dietitians in Nutrition Support Group; Member of American Society for Parenteral and Enteral Nutrition; Member of Ohio Society of Parenteral and Enteral Nutrition

Andrea K. JeVenn, RD, LD, CNSC

Title: Nutrition Support Clinician
Education: BS Human Nutrition, University of Massachusetts at Amherst; A.A.S. Culinary Arts, Johnson & Wales University, Providence, Rhode Island; Dietetic Internship: OSF St. Francis Medical Center, Peoria, Illinois
Specialty Areas: Nutrition Support, Gastrointestinal Nutrition, Nutrition-focused Physical Exam
Other: Member of American Society of Enteral and Parenteral Nutrition; Member of Ohio Society of Parenteral and Enteral Nutrition (Newsletter Committee); Member of Academy of Nutrition and Dietetics; Member of Dietitians in Nutrition Support

Amy Nishnick, RD, LD, CNSC

Title: Nutrition Support Clinician
Education: BS Nutrition, The Pennsylvania State University, University Park, Pennsylvania ; Dietetic Internship: Marywood University, Scranton, Pennsylvania
Specialty Areas: Home Parenteral Nutrition, Nutrition Support, Gastrointestinal Nutrition, Nutrition-focused Physical Exam

Leslie Shaw, RD, LD, CNSC

Title: Nutrition Support Clinician
Education: BS Dietetics, University of Akron, Akron, Ohio; Dietetic Internship: The Cleveland Clinic, Cleveland, Ohio
Specialty Areas: Nutrition Support, Colorectal Surgery, Nutrition-focused Physical Exam
Other: Member of Academy of Nutrition and Dietetics; Member of Dietitians in Nutrition Support Group; Member of Ohio Dietetic Association; Member of American Society for Parenteral and Enteral Nutrition

Jill Fisher, RD, LD, CNSC

Title: Nutrition Support Clinician
Education: BS Dietetics, University of Cincinnati, Cincinnati, Ohio; Dietetic Internship: Family Health Council, Inc., Pittsburgh, PA
Specialty Areas: Nutrition Support
Other: Member of Academy of Nutrition and Dietetics; Member of Ohio Dietetic Association, Member of Cleveland Dietetic Association

Monica Habib, MS, RD, LD, CNSC

Title: Nutrition Support Clinician
Education: MS Dietetics, Kent State University, Ohio; BS Dietetics, Youngstown State University, Ohio
Specialty Areas: Nutrition Support, Nutrition-focused Physical Exam
Other: Certified in Adult Weight Management; Member of Academy of Nutrition and Dietetics; Member of Dietitians in Nutrition Support; Member of Ohio Dietetic Association; Member of American Society for Parenteral and Enteral Nutrition

Ashley Andrews, MS, RD, LD

Title: Nutrition Support Clinician
Education: MS Clinical Nutrition, Rush University, Chicago, IL;  BS Dietetics Ohio University, Athens, Ohio; Dietetic Internship: Rush University Medical Center, Chicago, IL
Specialty Areas: Nutrition Support, Nutrition-focused Physical Exam
Other: Member of Academy of Nutrition and Dietetics; Member Dietitians in Nutrition Support Group; Member of American Society of Enteral and Parenteral Nutrition

Elizabeth Gallant, RD, LD

Title: Nutrition Support Clinician
Education: BS Dietetics, The Ohio State University, Ohio; Dietetic Internship: Cleveland Clinic, Cleveland, Ohio
Specialty Areas: Nutrition Support, Nutrition-focused Physical Exam
Other: Member of Academy of Nutrition and Dietetics; Member of Dietitians in Nutrition Support; Member of Ohio Dietetic Association; Member of American Society for Parenteral and Enteral Nutrition

Annette Pearson, BSN, RN, VA-BC

Title: Nutrition Support Nurse
Education: BS Nursing, Youngstown State University, Ohio
Specialty Areas: Infusion Nursing, Home Parenteral Nutrition, Nutrition Support
Other: Certified BLS Instructor, American Heart Association; Cleveland Clinic Vascular Access Resource Nurse; Member Infusion Nurses Society; Member NorthEast Ohio Association of Vascular Access

Marie (Dorothy) Emery, RN

Title: Nutrition Support Nurse
Education: AD Nursing, Cuyahoga Community College, Ohio
Specialty Areas: Home Parenteral Nutrition, Nutrition Support, Infusion Nursing
Other: Member of Association for Vascular Access

Our Services
  • Recommendations for appropriate nutrition support access and care
  • Management of electrolytes / fluids
  • Dietitians specialize in nutrition-focused physical exams and assessment
  • Physicians lead daily bedside rounds on hospitalized patients needing parenteral nutrition
  • Coordination of services with physicians, Intestinal Rehabilitation and Transplant Nutrition, Home Parenteral Nutrition clinicians, Home Health Care, and other multi-disciplinary services
  • Placement of small bowel feeding tubes
  • Provision of parenteral nutrition education to GI fellows, ICU residents, pharmacy residents, dietetic interns, visiting dietitians
Statistics / Accomplishments
  • More than 11,000 bags of TPN written last year (2011) by the Nutrition Support Team
  • Over 1,200 consults for parenteral nutrition in the hospital during 2011
Research / Publications

Publications

Dowhan L, DeChicco R. Developing and Implementing Competencies for Nutrition Support Dietitians. Support Line 2011:33(6):21.

Moccia L, DeChicco R. Abdominal Examinations: A Guide for Dietitians. Support Line 2011:33(2):16-21.

Austhof SI, Habib MA. Parenteral Feeding in Diabetes Patients. Today’s Dietitian 2011:13(12):44-7.

Logan K, Austhof S, Hamilton C, Nutrition Support: Indications and Efficacy. In: The Dietitian’s Hand book of Enteral and Parenteral Nutrition. 3rd Edition. Skipper A (ed.) pp22-45. Jones and Bartlett Publishers, Inc. 2011.

Rivera R, Campana J, Hamilton CH, Lopez R, Seidner DL. Small Bowel Feeding Tube Placement Using an Electromagnetic Tube Placement Device: Accuracy of Tip Location. JPEN. 2011:35(5):636-42.

DeChicco R, Neal T, Guardino J. Developing an Education Program for Nutrition Support Teams. Nutr Clin Pract. 2010:25:481-9.

Rhoda KM, Chhatriwalla EG, Parekh NR. Transitional Feeding: Challenges and Approaches. Support Line. 2008:30(4):21-28.

DeChicco R, Seidner DL, Brun C, Steiger E, Stafford J, Lopez R. Tip Position of Long-Term Central Venous Access Devices Used for Parenteral Nutrition. JPEN. 2007:31(5):382-7.

Parekh NR, McCrae JA. “Parenteral Nutrition” Lysen L. (Ed.) Quick Reference to Clinical Dietetics, 2nd ed. Jones and Bartlett Publishers, Inc., Sudbury, MA, 2006.

Gasser E, Parekh NR. Parenteral nutrition: Macronutrient composition and requirements. Support Line. 2005;27(6):6-12.

Professional Posters

DeChicco R, Austhof S, Rivera R, Speerhas R, Corrigan M, Steiger E. Type and Prevalence of Adverse Events During Cycling Process in Patients Being Prepared for Hospital Discharge on Parenteral Nutrition. Presented at the American Society for Parenteral and Enteral Nutrition Clinical Nutrition Week, Vancouver, Canada, 2011.

Rhoda K, DeChicco R. Support Knowledge of Physicians and Dietetic Interns Before and After a Comprehensive Training Program by a Multidisciplinary Nutrition Support Team. ASPEN, Las Vegas February 2010 - Clinical Nutrition Week

Presentations

(Roundtable) Emery M. Guide Patients in the Selection of Their Vascular Access Device for the Home Parenteral Nutrition Patient. ASPEN Clinical Nutrition Week, Las Vegas, NV 2/2010.

(Podium) DeChicco R. Documenting Severe and Non-Severe Malnutrition: A Hands-on Approach. Nutrition-Focused Physical Assessment. Pre-FNCE Workshop. San Diego, CA, 9/24/11

More Information

Nutrition Support Team Handbook

3rd Edition, 2010
Editors:
Kathy Logan Coughlin, MS, RD, LD, CNSD
Robert DeChicco, MS, RD, LD, CNSC
Cindy Hamilton, MS, RD, LD, CNSD

Learn from leaders in the field

The Nutrition Support Team Handbook is an ideal resource for medical professionals who are seeking a comprehensive resource on nutrition support practices. This handbook has been newly updated and expanded in 2010 to include the most recent standards of practice from ASPEN/SCCM Guidelines for Adult Critically Ill Patients and the Canadian Clinical Practice Guidelines, as well as a new section on intestinal rehabilitation and small bowel transplantation.

Features:

  • Comprehensive Nutrition Assessment
  • Estimating Nutritional Requirements
  • Enteral Nutrition and Access Issues
  • Calculating Parenteral Nutrition Prescriptions
  • Management of Metabolic Complications Associated with Parenteral Nutrition
  • Management of Nutrition Support in the Home Setting
  • A New Section on intestinal rehabilitation and small bowel transplantation
  • An Expanded Section on Special Disease Considerations in Nutrition Support

PLUS – included free with every order – a Pocket Card Guide for estimating nutritional requirements and calculating parenteral nutrition prescriptions.

In 1976, Cleveland Clinic created the Home Nutrition Support Service (HNSS), one of the first multidisciplinary programs of its kind in the United States, dedicated to care for patients at home with intestinal failure. High-tech catheters, pumps, and nutritionally complete intravenous fluids were used to safely “feed” these patients outside of a hospital setting. Specialists in these procedures taught patients how to monitor the overnight infusions, prepare the solutions, and care for their catheters while having access to the team professionals 24 hours a day, 7 days a week. Because of the new demand, a Cleveland Clinic home infusion company was established in the 1980’s to provide supplies and services in a more integrated fashion for patients living in Ohio and the surrounding region.

The HNSS has cared for people throughout the United States, as well as from other countries. Since its inception, over 1600 patients have been discharged on home parenteral nutrition (HPN) for reasons most often due to obstructive tumors, Crohn’s disease-related short bowel syndrome, adhesive obstructions, fistulas, and high output ostomies. Now the program has grown to require physicians, dietitians, nurses, a pharmacist, and clerical support to safely provide this complex therapy. HPN may only be required for short periods of time until the medical conditions allow for return to eating and drinking or tube feeding. HPN might also be required for years while still leading healthy, happy, and productive lives. Currently, the HNSS cares for several patients who have required HPN therapy for more than 20 years, and will continue to do so for the rest of their lives.

Department Contact Info
9500 Euclid Ave. TT2
Cleveland, OH 44195
216.444.5957

Our Services

HNSS advocates 24-hour clinician support (available by pager) and infection prevention, not only through optimal catheter-care, but also through the use of ethanol lock technology.

A comprehensive approach is applied to evaluate and care for patients in need of HPN including:

  • Physicians to oversee patient care, education, training, and research related to HPN therapy.
  • Nutrition Support dietitians perform nutrition assessments, establish individual nutrient needs, assist with determining home-going formulas and help ensure patient wellness and safety.
  • The Nutrition Support pharmacist reviews and optimizes parenteral formulas, monitors drug therapy dosing and drug-nutrient interactions, and assists with ensuring proper compounding and compatibility of HPN solutions.
  • Nutrition Support nurses provide evaluation and one-on-one training and education of infusion techniques, catheter care, pump operations, and home self-monitoring.
  • Case Managers identify insurance benefits and establish homecare pharmacy and nursing services.
  • Social Work and Psychiatric Services identify and help with social, emotional, and adjustment concerns.

After a home-going nutrition support formula is established and technical training is complete, patients are discharged from Cleveland Clinic with a visiting nurse who will continue to teach procedures in the home as needed. The HNSS clinicians work closely with home health care services and pharmacies throughout the country, including Cleveland Clinic Home Care. Regular laboratory work, intake and output records, and follow-up appointments with a Nutrition Support Team physician are necessary program components to avoid complications and to optimize outcomes. Dedicated HNSS clinicians attentively coordinate the care of all patients and are available to assist with immediate concerns.

Meet Our Clinicians

Karen Giaco, MS, RD, LD

Title: Manager, Home Nutrition Support and The Center for Gut Rehabilitation and Transplantation
Education: MS Nutrition and Dietetics, Akron University, Ohio; BS Chemistry, John Carroll University, University Heights, Ohio; Coordinated Undergraduate Program: Akron University, Ohio
Specialty: Home Parenteral Nutrition, Nutrition Support
Others: Member of American Society of Parenteral and Enteral Nutrition; Member of Ohio Society of Parenteral and Enteral Nutrition; Member of Academy of Nutrition and Dietetics; Clinical Nutrition Management DPG; Member of Ohio Dietetic Association

Denise Konrad, RD, LD, CNSC

Title: Home Nutrition Support Clinician
Education: BS Nutritional Science, Penn State, State College, PA; Dietetic Internship: Cleveland Clinic, Cleveland, Ohio
Others: Member of Academy of Nutrition and Dietetics

Ronelle Mitchell, RD, LD, CNSC

Title: Home Nutrition Support Clinician
Education: MA Physical Education/Exercise Science, California State University, Fresno, CA; BS Food Science & Nutrition, Colorado State University, Fort Collins, CO
Specialty: Home Parenteral Nutrition, Nutrition Support
Others: Member of Academy of Nutrition and Dietetics; Member of Dietitians in Nutrition Support Group; Member of American Society of Enteral and Parenteral Nutrition

Sandra I. Austhof, MS, RD, LD, CNSC

Title: Home Nutrition Support Clinician
Education: MS Nutrition, Case Western Reserve University, Cleveland, Ohio; B.S. Nutrition & Dietetics, Kent State University, Kent, Ohio; Dietetic Traineeship: MetroHealth Medical Center, Cleveland, Ohio
Specialty: Home Parenteral Nutrition, Nutrition Support, Gastrointestinal Nutrition
Others: Member of American Society for Parenteral and Enteral Nutrition; President-Elect, Ohio Society for Parenteral and Enteral Nutrition; Member of Academy of Nutrition and Dietetics; Public Policy Liason for Dietitians in Nutrition Support; Member of Ohio Dietetic Association

Marie (Dorothy) Emery, RN

Title: Nutrition Support Nurse
Education: AD Nursing, Cuyahoga Community College, Ohio
Specialty: Home Parenteral Nutrition, Nutrition Support, Infusion Nursing
Others: Member of Association for Vascular Access 

Annette Pearson, BSN, RN, VA-BC

Title: Nutrition Support Nurse
Education: BS Nursing, Youngstown State University, Ohio
Specialty Areas: Infusion Nursing, Home Parenteral Nutrition, Nutrition Support
Other: Certified BLS Instructor, American Heart Association; Cleveland Clinic Vascular Access Resource Nurse; Member Infusion Nurses Society; Member NorthEast Ohio Association of Vascular Access

Rex Speerhas, RPh, BCNSP

Title: Nutrition Support Clinical Pharmacist
Education: BS Pharmacy, Duquesne University
Others: Member of American Society of Enteral and Parenteral Nutrition; Member of Ohio Society of Enteral and Parenteral Nutrition; Member of American Diabetes Association; Member of Diabetes Association of Greater Cleveland

Statistics / Accomplishments
  • Grown to be one of the largest programs of its kind in the world - currently manages 5 times more patients than 10 years ago
  • Record number of patients (202) received care with the Cleveland Clinic HNSS in March 2012
  • Use of ethanol lock technology has prevented reoccurrence of blood stream infections. Our readmission rate for CRBSI/1000 catheter days is lower than the national average
Research / Publications

Publications

Corrigan M, Pogatschnik C, Konrad D, Kirby DF. Hospital Re-admissions for Catheter Related Blood Stream Infection and Use of ethanol lock therapy: Comparison of Patients Receiving Parenteral Nutrition in the Home versus a Skilled Nursing Facility. (Accepted for publication 3/2012 JPEN).

Corrigan M, Kirby DK. Impact of a National Shortage of Sterile Ethanol on Catheter Sepsis in a Home Parenteral Nutrition Practice: A Case Series. JPEN.

Corrigan M. Prevent Catheter Sepsis in Home PN Care. Today’s Dietitian. 2012:14(2)60-62.

Corrigan M, Kirby DF. Lock therapy update: Role in prevention of catheter related blood stream infections. OSPEN Access. 2011:18(3)1-3.

Corrigan M. Complications of Home Parenteral Nutrition. Support Line. 2011:33(6)3-12.

Speerhas RA, Seidner DL. Measured versus estimated aluminum content of parenteral nutrient solutions. Am J Health-Syst Pharm. 2005:64:740-46.

Chadalavada R, Parekh NR, Lopez R, Summers K, Bolwell B, Steiger E, Seidner DL. Adequate home parenteral nutrition does not improve lean body mass in bone marrow transplantation patients with graft versus host disease. Clinical Nutrition. 2005:24(4):S680.

Professional Posters

Corrigan M, Konrad D, Hamilton C, Steiger E, Kirby DK. Identification and Early Treatment of Dehydration in Home Parenteral Nutrition and Home Intravenous Fluid Patients prevents Hospital Admissions. ASPEN CNW 2012, Florida.

Speerhas, Rex. Adverse Events During Cycling Process in Patients Being Prepared for Hospital Discharge on Parenteral Nutrition, Clinical Nutrition Week, Vancouver, BC, Jan 27, 2011

Chadalavada R, Parekh NR, Lopez R, Summers K, Bolwell B, Steiger E, Seidner DL. Adequate Home Parenteral Nutrition Does Not Improve Lean Body Mass in Bone Marrow Transplantation Patients with Graft Versus Host Disease.

Download a poster

Presentations

(Roundtable) Speerhas, Rex. Ethanol Lock to Prevent CRBSI; Clinical Nutrition Week, Vancouver, BC, Jan 28, 2011

(Webinar) Speerhas, Rex. Blood Glucose Management When Transitioning from Hospital to Home on Specialized Nutrition Support; ASPEN webinar, June 8, 2011

(Presentation) Speerhas, Rex. Emerging Trends in Parenteral Nutrition; Home Healthcare professionals, Columbia Md., July 21, 2011

More Information

The Cleveland Clinic provides detailed, hands-on Home Enteral Nutrition (HEN) education for patients and caregivers who require HEN therapy upon discharge, thanks to a specialized group of registered dietitians. Since 1985, our adult HEN Team has played an active role in affecting a smooth transition for patients leaving the hospital with enteral nutrition. Patients and their caregivers are taught how to be independent with feeding through written instruction and one-on-one demonstrations.

The dietitians also coordinates with other healthcare members to determine the appropriateness of HEN therapy, type of enteral access necessary, formula selection, method of feeding administration, and to define the patients’ short and long-term nutrition goals.

In 2011, these dietitians provided over 400 HEN instruction sessions.

Department Contact Info

Bonnie Rigutto, MEd, RD
Inpatient Nutrition Therapy Manager
Nutrition Therapy
216.444.6103
riguttb@ccf.org

Arlene Escuro, MS, RD, CNSC
Adult HEN Team Coordinator
Nutrition Therapy
216.444.6658
escuroa@ccf.org

Kathy Barco, RD, LD, CNSC
Outpatient Home Enteral Nutrition Coordinator
Nutrition Therapy
216.444.3046
barcok@ccf.org

More Information

Enteral access nurses are specially trained to place nasally-inserted small bowel feeding tubes, with the aid of an electromagnetic device. These tubes generally benefit patients who have functioning gastrointestinal (GI) tracts, but are unable to take adequate oral nutrition.

The electromagnetic device enables the nurse to visualize the feeding tube as it travels through the GI tract. This technique can be performed quickly at the bedside without additional sedation, personnel assistance, or cost of repeated radiographs to verify tube placement. This facilitates early enteral nutrition, which promotes healing and decreases hospital length of stay. Enteral access nurses are also specially trained in use of nasal bridles to prevent easy dislodgement of the tubes.

Our enteral access nurses perform more than 180 feeding tube placements monthly and have placed more than 5,000 tubes since the program was established. They are also actively involved in training Nutrition and GI Fellows on placing small bowel feeding tubes and the technique for nasal bridling.

Meet Our Nurse

Jeanmarie Campana, RN

Title: Enteral Access Nurse / Professional Nurse III
Education: AD Nursing, Vincennes University, Vincennes, Indiana; MSN Candidate, American Sentinel University
Specialty: Small bowel feeding tube placement in the critically ill
Other: Member of Ohio Society of Parenteral and Enteral Nutrition; Co-chair, Scholarship Committee; Member of American Society for Parenteral and Enteral Nutrition; Co-author, Enteral Nutrition Practitioner Online Tutorial

Academy of Nutrition and Dietetics
120 South Riverside Plaza, Suite 2000
Chicago, IL 60606-6995
Toll-free: 800.366.1655 or toll-free 800.877.1600
Fax: 312.899.4899

American Society for Parenteral and Enteral Nutrition
8630 Fenton St., Ste. 412
Silver Springs, MD 20910
Phone: 301.587.6315

The Oley Foundation
214 Hun Memorial, A-28
Albany Medical Center
Albany, NY 12208-3478
Toll-free: 800.776.OLEY

Crohns & Colitis Foundation of America, Inc.
386 Park Avenue South, 17th Floor
New York, NY 10016-8804
Phone: 212.685.3440
Toll-free 1.800.932.2423 
Email: info@ccfa.org

American College of Gastroenterology
P.O. Box 342260
Bethesda, MD 20827-2260
Phone: 301.263.9000

American Gastroenterological Association
4930 Del Ray Avenue
Bethesda, MD 20814
Phone: 301.654.2055
Fax: 301.654.5920
Email: info@gastro.org or webmaster@gastro.org

American Society for Gastrointestinal Endoscopy
1520 Kensington Rd., Suite 202
Oak Brook, IL  60523
Phone: 630.573.0600

Foundation for Digestive Health and Nutrition
4930 Del Ray Avenue
Bethesda, MD 20814-3015
Phone: 301.222.4002

Schedule an Appointment Online

Call us for an Appointment

To find a digestive specialist for your needs, contact the Digestive Disease Institute at 216.444.7000 (or toll-free 1.800.223.2273, ext. 47000)

Same-day Appointments

To arrange a same-day visit, call 216.444.7000

This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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