Practical recommendations on order of addition, labelling, storage, quality control, and administration in parenteral nutrition

Abstract

The preparation of parenteral nutrition (PN) admixtures involves a high degree of technical and clinical complexity, requiring standardized and safe procedures. This review article, developed within the framework of the Spanish consensus on PN preparation, presents practical recommendations on key aspects of the formulation and use of PN, including the order of component addition, final product labeling, appropriate storage conditions, and essential quality control measures prior to administration. The guidelines provided here were developed using an adapted Delphi methodology, based on a comprehensive review of scientific evidence and the clinical experience of expert professionals. A logical sequence of addition is proposed to reduce the risk of physicochemical incompatibilities, such as calcium phosphate precipitation or lipid emulsion destabilization. Furthermore, the importance of accurate labeling is emphasized as a tool for traceability and clinical safety, especially in high-risk settings. Quality control procedures-including gravimetric, physicochemical, and microbiological checks-are detailed, alongside recommendations for proper storage (refrigeration, light protection) and the use of in-line filtration during administration. This document offers a comprehensive and updated framework to standardize pharmaceutical and clinical practices, ultimately improving the quality, safety, and efficacy of intravenous nutritional therapy.