What it is (overview)

Peritoneal Catheter Reposition with Imaging Guidance is a minimally invasive procedure used to move (reposition) a peritoneal dialysis (PD) catheter to a better location inside the abdominal cavity when it is not working properly. The catheter is the soft tube that allows dialysis fluid to flow into and out of the belly for renal therapy in people with reduced kidney function.

During the procedure, a specialist uses medical imaging—most commonly fluoroscopy (real-time X-ray) and sometimes ultrasound—to see the catheter’s position and guide it back into the ideal place (often the lower pelvis). Imaging guidance helps the clinician avoid nearby organs and improves accuracy compared with “blind” repositioning.

This is not a blood test and it does not “measure” a lab value. Instead, the “result” is procedural: whether the catheter tip is successfully relocated and whether fluid flows as it should. A successful outcome usually means:

• Better drainage and fill of dialysis fluid
• Improved dialysis effectiveness (clearance) and comfort during exchanges
• Lower risk of ongoing dialysis complications related to poor catheter position

If repositioning is not successful, it may suggest an underlying issue such as blockage from fibrin, constipation-related pressure, adhesions/scar tissue, catheter kinking, or catheter migration that may require additional treatment or, in some cases, surgery or catheter replacement.

When & why it's usually done

This procedure is typically done in people who are already on peritoneal dialysis and develop signs that the PD catheter is not positioned correctly or is not functioning well. Your dialysis team may recommend catheter repositioning with imaging guidance when there is concern that the catheter tip has moved out of place or is not draining properly.

Common reasons include:

• Poor drainage (slow outflow, incomplete drainage, or frequent drain alarms on a cycler)
• Fill problems (fluid won’t run in easily) or “one-way” flow (fills but won’t drain, or vice versa)
• New abdominal pain or pressure during exchanges that suggests malposition or irritation
• Suspected catheter migration (catheter tip moved away from the pelvis)
• Recurrent catheter dysfunction despite troubleshooting (position changes, laxatives for constipation, flushes)
• Catheter-related complications such as kinking, omental wrapping, or fibrin-related obstruction (sometimes addressed along with repositioning)

Imaging guidance is often chosen because it allows the clinician to confirm catheter location in real time, improves the chance of restoring good flow, and can reduce the need for more invasive procedures. It may be used as an intermediate step before surgical revision, especially when the goal is to keep you on peritoneal dialysis safely and effectively.

Common diseases related to it

• Chronic kidney disease (CKD)
• End-stage renal disease (ESRD) requiring peritoneal dialysis
• Peritoneal dialysis catheter malfunction or migration
• Peritoneal adhesions (scar tissue), including after prior abdominal surgery
• Constipation contributing to PD outflow obstruction
• Fibrin blockage or catheter occlusion
• Omental wrapping/entrapment of the catheter
• Peritonitis and other dialysis-related infections (as a complication that may coexist with catheter problems)

Health goals where it may help

• Improve peritoneal dialysis performance by restoring reliable inflow and outflow
• Support ongoing kidney replacement therapy and help avoid unplanned switches to hemodialysis
• Reduce dialysis complications such as recurrent catheter dysfunction, pain with exchanges, and inadequate clearance
• Maintain treatment continuity and quality of life for people managing advanced kidney disease
• Enhance patient care by using imaging-guided techniques to improve accuracy and safety
• Minimize the need for more invasive surgery when a catheter can be corrected with image-guided repositioning