Annals of Clinical Nutrition and Metabolism

Guideline

A practical guide for enteral nutrition from the Korean Society for Parenteral and Enteral Nutrition: Part III. preparation of enteral nutrition formulas: In Seok Lee, Ye Rim Chang, Bo-Eun Kim, Youn Soo Cho, Sung-Sik Han, Eunjung Kim, Hyunjung Kim, Jae Hak Kim, Jeong Wook Kim, Sung Shin Kim, Eunhee Kong, Ja Kyung Min, Chi-Min Park, Jeongyun Park, Seungwan Ryu, Kyung Won Seo, Jung Mi Song, Minji Seok, Eun-Mi Seol, Jinhee Yoon, Jeong-Meen Seo, for the KSPEN Enteral Nutrition Committee; Ann Clin Nutr Metab 2026;18(1):3-9. Published online March 30, 2026; DOI: https://doi.org/10.15747/ACNM.26.0046

Abstract PDF: Purpose
This guideline was developed to provide evidence-based recommendations for the safe preparation and handling of enteral nutrition (EN) formulas in order to improve patient safety and promote standardized clinical practice in Korea.
Methods
The key questions addressed the selection of open versus closed feeding systems, the safe preparation and handling of EN formulas, precautions related to blenderized tube feeding (BTF), and essential labeling requirements. Recommendations were drafted and refined through multidisciplinary expert consensus under the auspices of the Korean Society for Parenteral and Enteral Nutrition (KSPEN).
Results
The choice of feeding system should be determined according to the patient’s condition, risk of infection, and anticipated duration of feeding. Closed feeding systems are recommended because they reduce contamination risk and nursing workload, whereas open feeding systems require strict adherence to aseptic technique. For open or reconstituted EN formulas, hang time at room temperature should not exceed 4 hours, whereas closed feeding systems should follow the manufacturer’s recommended hang time. For BTF, administration time should be limited to 2 hours to minimize bacterial growth, and their use is contraindicated in medically unstable or immunocompromised patients. Accurate labeling, including patient identifiers, formula information, administration route, and hang time, is essential to prevent administration errors.
Conclusion
These guidelines provide a practical framework for the safe preparation and management of EN formulas. Adherence to standardized preparation protocols, including appropriate feeding system selection and strict hygiene practices, is essential for reducing complications and improving the safety of EN therapy.

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