OBJECTIVE. The purpose of this article is to detail a percutaneous approach to placing peritoneal catheters using sonographic and fluoroscopic guidance. Fluoroscopic-assisted placement of these catheters has been previously described in the literature. We emphasize the use of additional sonographic guidance, including color Doppler sonography, to determine the safest puncture site and to guide the initial needle puncture to avoid bowel perforation and injury to the epigastric artery. CONCLUSION. Imaging-guided-that is, sonography plus fluoroscopy-percutaneous placement of peritoneal catheters is a safe, minimally invasive, and effective alternative to blind or open surgical placement. The use of sonographic guidance together with fluoro-scopic assistance makes placement of peritoneal catheters a safer and effective alternative to blind or open surgical placement. © American Roentgen Ray Society.