Peritoneal catheters are relatively easy to insert but are associated with specific complications. Proper placement and appropriate management reduce the problems associated with these complications, reduce morbidity and mortality, and increase catheter survival. On the basis of our findings the following procedures are recommended: placement of the catheter in the operating room, use of a paramedian incision, closure of the fascia with a running nonabsorbable suture, use of small exchanges initially to allow for healing, cessation of peritoneal dialysis for a limited time when leaks occur, performance of omentectomy when necessary, repair of abdominal wall hernias preoperatively or whenever they occur, maintenance of meticulous asepsis, removal of the catheter after fungal peritonitis or multiple episodes of peritonitis with the same organism, and early operation if there is any doubt of an intraabdominal catastrophe.