What it is (overview)

Peritoneal catheter placement with imaging guidance is a minimally invasive procedure in which a doctor inserts a soft, flexible tube (a peritoneal catheter) into the peritoneal cavity—the space inside the abdomen that surrounds the intestines and other organs. The catheter creates a safe pathway to either drain abdominal fluid (ascites or infected fluid) or to perform peritoneal dialysis (a type of dialysis done through the belly).

During the procedure, the clinician uses imaging guidance—most often ultrasound, fluoroscopy (real-time X-ray), or both—to see the abdominal structures and guide the catheter into the correct position. Imaging helps the team avoid blood vessels and bowel, confirm that the catheter tip sits where it should, and reduce the risk of complications such as bleeding, organ injury, or catheter malfunction.

This is not a blood or urine “lab test” that produces numbers. Instead, it is a diagnostic and therapeutic procedure. “Results” are typically described in terms of:

1) Technical success: The catheter is placed in the intended location and works properly (fluid drains and/or dialysis fluid can be infused and removed).

2) Findings from the drained fluid (if collected): If abdominal fluid is removed, it may be sent to the laboratory to evaluate for infection, inflammation, or cancer. Common tests include cell count, culture, albumin/protein, and cytology. Results may indicate, for example, infection (such as spontaneous bacterial peritonitis), bleeding, or malignant cells.

3) Post-procedure status: Improvement in symptoms (less abdominal swelling or pain, easier breathing), and whether any complications occurred (such as leakage, blockage, or infection).

When & why it's usually done

Doctors commonly recommend peritoneal catheter placement with ultrasound or fluoroscopy when a person needs reliable access to the abdomen for ongoing treatment or evaluation. It may be done urgently (to relieve pressure or treat suspected infection) or planned in advance (to start peritoneal dialysis).

It’s usually done to:

Start or maintain peritoneal dialysis: People with advanced kidney disease may choose peritoneal dialysis at home. A properly placed catheter is essential to deliver dialysis solution into the abdomen and drain it out efficiently.

Drain recurrent or symptomatic abdominal fluid (ascites): Excess fluid can cause belly distention, discomfort, reduced appetite, nausea, and shortness of breath. A catheter can allow repeated drainage, especially when fluid returns frequently.

Evaluate the cause of abdominal fluid: If the reason for fluid buildup is unclear, your clinician may remove fluid through the catheter (or during placement) for diagnostic testing—helping evaluate liver disease, cancer, heart failure, or infection.

Treat or manage infections in the peritoneal space: In selected cases, access to the peritoneal cavity supports diagnosis and treatment planning when peritonitis or other abdominal infections are suspected.

Symptoms or situations that may prompt it include:

• Visible abdominal swelling or rapid weight gain from fluid
• Abdominal pressure, pain, or early fullness when eating
• Shortness of breath related to abdominal distention
• Need for ongoing dialysis due to chronic kidney failure/end-stage kidney disease
• Recurrent ascites that requires frequent drainage
• Prior abdominal surgery or complex anatomy where imaging guidance improves safety and accuracy

Why imaging guidance matters: Ultrasound and fluoroscopy help the clinician choose the safest entry site, guide the catheter past sensitive structures, confirm correct placement, and improve function—supporting fewer complications and better long-term performance of the catheter.

Common diseases related to it

• Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) requiring dialysis
• Ascites due to liver cirrhosis (including portal hypertension)
• Spontaneous bacterial peritonitis (SBP) and other causes of peritonitis
• Malignant ascites from cancers (e.g., ovarian, gastrointestinal, pancreatic cancers)
• Congestive heart failure–related fluid overload with abdominal fluid accumulation
• Nephrotic syndrome and other causes of low-protein states associated with ascites
• Abdominal diseases causing fluid collections (selected cases), such as inflammatory or postoperative fluid buildup

Health goals where it may help

• Enable home-based renal replacement therapy through peritoneal dialysis
• Relieve symptoms from abdominal fluid (reduce bloating, pressure, and shortness of breath)
• Support diagnosis of the cause of ascites by allowing safe fluid sampling for laboratory testing
• Reduce emergency visits by providing reliable access for recurrent abdominal fluid drainage
• Improve quality of life and daily function in people with chronic abdominal fluid buildup
• Support safer, more accurate catheter placement using ultrasound and/or fluoroscopy to minimize complications