Parenteral Nutrition Ordering, Order Review, Compounding, Labeling, and Dispensing

Publication Date: February 14, 2014


We suggest providing education to healthcare professionals to improve PN ordering, thereby reducing errors. (W)

We suggest that PN with an osmolarity up to 900 mOsm/L can be safely infused peripherally. Higher osmolarity limits, especially when peripheral PN is prepared as a TNA, may also be tolerated, but the evidence to support a safe limit is lacking. (W)

We recommend an elemental calcium intake of 76 mg/kg per day for shortterm PN in neonates. (S)
We suggest a Ca:P ratio of 1.7:1 (mg:mg) or 1.3:1 (mmol:mmol) in shortterm PN in neonates. (W)

We suggest that commercially available premade multichambered PN formulations be considered as an available option for patients alongside compounded (customized or standardized) PN formulations to best meet an organization’s patient needs. (W)

We suggest that there is no clinical difference in infectious complications between the two PN delivery systems. 3-in-1 formulations administered in the homecare setting may increase the risk for catheter occlusion and shorten catheter lifespan. (W)

We recommend that TNAs maintain final concentrations of amino acid ≥4%, monohydrated dextrose ≥10%, and injectable lipid emulsion ≥2% to be more likely to remain stable for up to 30 h at room temperature (25°C) or for 9 d refrigerated (5°C) followed by 24 h at room temperature. (S)

We cannot make a recommendation due to the multiple variations in amino acid concentrations, PN volume, pH, presence or absence of fat emulsion, or the amounts of other minerals (eg, magnesium). We suggest published graphs for specific products provide adequate guidance; however, no evidence indicates that these formulations remain stable for >24–48 h. (W)

We suggest that, given the level of mineral contamination found in parenteral stock solutions used to compound PN admixtures, practitioners purchase products that accurately describe levels of contamination and also take that exposure into account when recommending or reviewing trace element dosing. (W)

We recommend that non-nutrient medication be included in PN admixtures only when supported by:
  • (1) pharmaceutical data describing physicochemical compatibility and stability of the additive medication and of the final preparation under conditions of typical use and
  • (2) clinical data confirming the expected therapeutic actions of the medication; extrapolation beyond the parameter limits (eg, products, concentrations) of the given data is discouraged.

We suggest that heparin not be included in PN admixtures for reducing the risk of central vein thrombosis. (W)

We recommend against the repackaging of IVFE into syringes for administration to patients. We suggest that other methodologies for repackaged IVFE, such as drawn-down IVFE units, are preferable. (S)

(a) We recommend that the BUD for unspiked IVFE in the original container should be based on the manufacturer’s provided information. The BUD for IVFE in the original container spiked for infusion should be 12–24 h.

(b) Although repackaged IVFE is not recommended, when used, the BUD for IVFE transferred from the original container to another container for infusion separately from a 2-in-1 PN solution should be 12 h. (S)

BUD, beyond-use date; Ca, calcium; IVFE, intravenous fat emulsions; P, phosphate; PN, parenteral nutrition; TNA, total nutrient admixture. Strength of recommendation makes use of evidence from in vitro studies.

Recommendation Grading




Parenteral Nutrition Ordering, Order Review, Compounding, Labeling, and Dispensing

Authoring Organization

Publication Month/Year

February 14, 2014

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Emergency care, Hospital, Long term care

Intended Users

Dietician nutritionist, nurse, nurse practitioner, physician, physician assistant



Diseases/Conditions (MeSH)

D044623 - Nutrition Therapy


parenteral nutrition, nutritional support

Supplemental Methodology Resources

Data Supplement