Peritoneal dialysis catheter

Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns - "Catheter occlusions secondary to fibrin or blood clot can be managed with tissue plasminogen activator (TPA). Two milligrams of TPA reconstituted in 40 cc of normal saline, and instilled in the catheter for 1 h, resulted in restoration of patency in 57 % of catheters [26]. Another technique described is the use of an endoscopic retrograde cholangiopancreatography cytology brush to manipulate a malfunctioning PD catheter, with subsequent flushing of the catheter with heparinized saline through the injection port to remove any clot or fibrin."

A six-year-old girl with end stage renal disease has had a peritoneal dialysis catheter in place for nine months. She was treated with antibiotics for bacterial peritonitis three months ago and did well until last week when her catheter stopped working well. The effluent cultures reveal a fungal species. What is the next best next step in her management? [size=20px]A Catheter removal and placement of temporary hemodialysis catheter B Catheter removal and placement of new catheter on opposite side C Antifungal therapy administered through the catheter D Laparoscopic omentectomy and catheter reposition [/size]

see video link in second post

see video link in second post