The Pleurx subcutaneous tunneled catheter is approved for repeated, long-term drainage of malignant pleural effusions; however, there is limited literature describing its use in malignant ascites. The authors compared the safety and efficacy of two percutaneous drainage methods: large volume paracentesis and Pleurx catheter placement over a 41-month period. The Pleurx catheter provided effective palliation with a complication rate similar to that for large volume paracentesis, while preventing the need for frequent trips to the hospital for repeated percutaneous drainage.