Systems and methods for gaining percutaneous access to a body lumen, preferably without a guidewire, are provided herein. The system can include a tubular medical device and a needle with a distal tip. A side port is provided through a wall of the tubular medical device, to be in communication with a distal end opening of the device via a passageway. The needle can be positioned within the side port to extend the distal tip beyond the distal end opening. In this position, the distal tip can form an entry opening in the body lumen, and a distal portion of the device can be advanced over the indwelling needle into the entry opening. The needle can then be withdrawn from the tubular medical device, while maintaining a portion of the tubular medical device in place within the body lumen.
