A medical device for creating access through tissue is disclosed. In an embodiment, the device facilitates puncturing of tissue at a target access site while limiting the risk of perforating other tissue adjacent the target site. For example, the device may be used to puncture the atrial septum for access into the left atrium from the right atrium. According to aspects of this disclosure, the device integrates a puncturing needle into a dual lumen elongate tube. The extension of the needle beyond the distal endface of the elongate tube may be limited by an actuator coupled in the handle of the device.
