Wanted to pick your brain about a patient. Patient has  hemodialysis catheter and an incidental echo and a transesophageal echo cardio gram picked up a 2 cm clot at the tip of the catheter. Blood cultures are negative but infectious diseases wants to remove the catheter. It’s working fine. Concerns about removing the catheter includes dislodgment of the 2 cm clot into the lungs. One thought is to infuse TPA to try to make the clot smaller another thought is a rather drastic step to perform open heart surgery to remove the clot. It’s possible that we have inadvertently removed such catheters  and patients have done fine but having known about this problem how would you approach it. Is there any literature to support any particular action