The need for guidelines on the use of concentrated nutritional solutions to achieve effective total parenteral nutrition has become very evident in our hospitals. As these are teaching hospitals, our physicians write TPN orders for short-term surgical patients, long-term patients (home TPN), burn patients, neonatal patients and selected cancer patients. This variance in patients, coupled with the rotation of the interns and resident house staff, has resulted in a need for a TPN protocol. Within the framework of this protocol, each patient can be approached. The pharmacy's approach to this problem was to convene an Ad Hoc Committee for the purpose of developing a protocol and in early 1975 the protocol was submitted to our Pharmacy and Therapeutics Committee. The Committee approved its acceptance, and it was forwarded to the Medical Staff Advisory Committee and was approved. Since that time, new developments and the inclusion of other pertinent material have necessitated updating our protocol. The update has resulted in the following protocol.