Spanish consensus on the preparation of parenteral nutrient mixtures - General aspects

Abstract

Parenteral nutrition (PN) is a complex therapeutic intervention, particularly in pediatric and critically ill patients, requiring strict standards of safety, stability, and compatibility during its preparation. To update and harmonize clinical practice, the Pharmacy Working Group of the Spanish Society of Clinical Nutrition and Metabolism (SENPE) and the Spanish Society of Hospital Pharmacy (SEFH) have developed a new multidisciplinary consensus. This document addresses key practical questions and provides recommendations grounded in scientific evidence and clinical experience. The consensus focuses on six key areas related to PN preparation: lipid emulsion stability and lipid peroxidation; calcium-phosphate precipitation risk; stability of amino acids, vitamins, and trace elements; quality control and labeling; automated compounding systems and multi-chamber bags; and drug-PN compatibility. It outlines strategies to minimize physicochemical instability, including guidelines on analytical techniques, the recommended sequence of component addition, and preventive measures to avoid destabilization phenomena. This document serves as a practical guide for healthcare professionals involved in the compounding and administration of PN across various clinical settings. Recommendations were developed using a structured consensus methodology (adapted Delphi technique) and were unanimously endorsed by all participating experts. The result is a reference tool that supports safety, quality, and efficiency in PN preparation throughout Spain.