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The addition of heparin to the PN solution at a concentration of 0.5 to 1 units per mL (36) maintains the patency of the venous catheter, reduces vein irritation, and enhances lipid clearance by improving lipoprotein lipase enzyme activity. Heparin should not be used in patients with bleeding or at risk for bleeding, or in patients with thrombocytopenia.

Histamine-2 receptor antagonists such as ranitidine, famotidine, and cimetidine are compatible with PN and may be added to the PN solution for stress ulcer prophylaxis.

Regular insulin is compatible with the PN solution. However, insulin therapy is difficult to regulate in infants, and intravenous insulin should be administered as a separate intravenous infusion to allow safe titration of the insulin dose in this circumstance.

Iron deficiency anemia may occur in PN-dependent patients. Iron is not routinely added to PN. Iron dextran is the most common parenteral iron available for use when oral iron absorption is unreliable or results in gastrointestinal intolerance. Because iron can be used as a substrate for bacterial proliferation, iron dextran should be avoided in infected patients.