Objective To evaluate the efficacy and safety of modified percutaneous peritoneal dialysis (PD) catheterization techniques in pediatric uremic patients, and to compare the clinical advantages and limitations of three distinct modified approaches. Methods A single-center retrospective cohort study was conducted, enrolling pediatric patients who underwent their first percutaneous PD catheterization for uremia at the department of nephrology between January 1, 2017 and December 31, 2024. Patients were stratified into three groups based on the catheterization technique: Group A (puncture cannula combined with rigid guidewire-guided technique), Group B (peel-away sheath combined with rigid guidewire-guided technique), and Group C (pneumoperitoneum-assisted trocar combined with rigid guidewire-guided technique). Baseline characteristics, procedural duration, incidence of intraoperative incision bleeding, time to initiation of dialysis, and incidences of catheter dysfunction and PD-related infections within 1 year of regular PD initiation were collected and analyzed statistically. Results A total of 98 patients were included, with well-balanced baseline characteristics across groups. All patients received regular PD for≥1 month; 75 completed≥6 months of PD, and 53 completed≥12 months. Procedural duration differed significantly among the three groups (P<0.05), with Group C having the shortest duration (significantly shorter than Group A, P<0.01). Cross-sectional analyses at postoperative time points revealed no significant differences in incision bleeding, time to dialysis initiation, poor drainage, leakage, or PD-related infections (P>0.05). Kaplan-Meier survival analysis showed 1-year catheter survival rates of 0.89, 0.79, and 0.96 in Groups A, B, and C, respectively. However, Cox proportional hazards regression demonstrated no significant difference in 1-year catheter survival among the three techniques. Further survival analyses for key catheter-related adverse events showed no significant intergroup differences in 1-year tunnel infection or peritonitis rates. Notably, Group C had a significantly higher incidence of poor drainage than Group A (P=0.034). Conclusion Modified percutaneous PD catheterization is a safe, effective, and technically feasible approach suitable for dissemination among pediatric nephrologists. The peel-away sheath combined with rigid guidewire technique exhibits the most balanced performance in terms of procedural efficiency and complication control. While the pneumoperitoneum-assisted trocar technique significantly shortens procedural duration, it may increase the risk of postoperative poor drainage, warranting selective application in centers with proficient technical expertise.