A guide wire exchange system including an elongate, flexible, guide wire exchange catheter capable exchanging one guide wire for another in a safe, efficient, and secured manner, where a primary guide wire, after having been advanced through the body, is to be replaced with a secondary guide wire that is to be securely advanced through the body to the target site by the advancement of the exchange catheter over the path of the primary wire. The exchange catheter may include a securement element in order to releasably secure at least one guide wire to the exchange catheter at or near the distal end of the exchange catheter. Once secured, both the exchange catheter and the secured guide wire(s) may be advanced or retracted in a synchronous manner, without the possibility of divergence at the distal ends of the secured components as they are being manipulated by an operator.