Standard therapy of catheter-related sepsis of long-term, tunnelled, silicone dialysis catheters is catheter removal, parenteral antibiotics, and catheter replacement in a new venous site after documented clearing of bacteremia. This leads to loss of future venous access sites. Thirteen consecutive cases of dialysis catheter-related sepsis in 10 patients successfully managed by guidewire exchange with preservation of the same central venous access site are reported. Although the most common cause of catheter sepsis in this series was coagulase-negative staphylococcus, guidewire exchange also was successful in cases due to gram-negative rods and yeast. To preserve future venous access sites in the chronic hemodialysis population, long-term, tunnelled dialysis catheter-related sepsis should be managed by a short course of parenteral antibiotics and by changing the catheter over a guidewire using the same venous insertion site.