A system for use in accessing a patient's central venous system at a desiredtarget point from aremote entry point. The system includes a guide catheter work station having aworking lumenwhich is introduced into the venous system at the remote entry site anddelivered proximal to thedesired target site. A dilation stylet is placed in the guide catheter workstation, and a needlewire directional guide is delivered through the dilation stylet. The needlewire directional guideis rotated and positioned to aim the tip of the needle wire directional guidetoward the exteriorexit target location. A needle wire having a tissue piercing tip is advancedthrough the needlewire directional guide so that it exits the venous system and creates an extravascular tissue trackextending to said exterior exit target location.
