Are there instances when you do not recommend tunneled dialysis catheter exchange in patients on hemodialysis who are found to have bacteremia?  

Generally, the answer is no. The only situation I would not recommend tunneled catheter exchange is if the patient has "run out" of catheter insertion sites and removal of the catheter poses the risk of not being able to place another tunneled catheter. That is also tempered by the organism causing ...

I follow the IDSA guidelines. Do exchange catheters for Staph and Candida infections all the time. For gram-negative infections and coag-negative infections, if the patient is well after a course of antibiotics, I don't necessarily remove the catheter. Mermel et al., PMID 19489710