Catheter exchange systems and methods may use a cutting tool to sever an encrusted catheter. The cutting tool may include a flexible cannula to encompass and move along the encrusted catheter. A sheath may selectively cover the cutting tool. The cutting tool may selectively transition between a first position in which the cutter is within the sheath and a second position in which the cutting tool is extended beyond the sheath to sever a suture of the catheter. A locking stylet may be used to secure the position of the encrusted catheter and remove the encrusted catheter.