© 2016 Nova Science Publishers, Inc. Malignant ascites can be the primary presenting sign of malignancy in up to 50% of patients who suffer from ascites due to neoplastic disease. Although malignant ascites account only for 10% of all causes of ascites but its presence is a sign of advanced malignancy and associated with poor prognosis with a very short life expectancy. Ovarian cancer is considered the most common cause of malignant ascites. However, other intra-abdominal neoplasm can be associated with malignant ascites. Symptomatic treatment of malignant ascites is quite important alongside therapeutic management of the primary neoplasm in attempt to relieve the patients’ complaints and improve their quality of life. Many palliative management plans for malignant ascites are available, ranging from medical treatment to invasive surgical procedures. However, there is not a standardized management protocol for refractory malignant ascites. The anticipated short-term survival of most patients with malignant ascites favors minimally invasive palliative management. Tunneled catheters have been used for peritoneal dialysis with good outcome and relatively low complication rates, which led to the idea of using peritoneal dialysis catheters for palliative management of patient with malignant ascites. Moreover, a newly introduced, specially designed, subcutaneous implanted port connected to a tunneled intraperitoneal draining catheter to drain ascites is available in the market. In this book chapter, we aim to address the mechanism of malignant ascites production and cover all clinical aspects of tunneled catheters and tunneled ports including indication, contraindication, device design, technical procedure considerations and, complication. We will summarize the current status of tunneled catheters and peritoneal ports and compare it to other palliative options for management of malignant ascites.