Sheathless guide, rapid exchange dilator and associated methods

An apparatus configured for a percutaneous access site, comprising:

• an elongate member configured for passage of fluid through a lumen of the elongate member;
• wherein the elongate member is configured for passage of a guide wire through only a portion of the elongate member;
• wherein the guide wire is displaceable along the portion of the elongate member through a first opening of the elongate member;
• wherein the elongate member comprises an angled guiding surface configured to direct the guide wire out of a second opening of the elongate member, the angled guiding surface permanently attached to and extending from a surface of the lumen opposite of the second opening of the elongate member to a position at or adjacent a proximal portion of the second opening and wherein the angled guiding surface comprises a fluid passage configured for the passage of fluid through the lumen of the elongate member;
• and
• wherein a portion of an outside surface of the elongate member extending from a proximal end of the second opening comprises a recess disposed on the outside surface configured to accommodate a portion of the guide wire, and aid in disposition of the apparatus in combination with the guide wire through a patient's percutaneous access site and/or vasculature.

A method of accessing a percutaneous site of a patient, comprising:

• inserting a proximal end of a first guide wire through an opening at or adjacent a distal end of a dilator, wherein a portion of the dilator is disposed within a catheter;
• threading the first guide wire through both of a portion of a lumen of the dilator and a port disposed in a sidewall of the dilator,
• wherein threading the first guide wire comprises advancing the first guide wire to a plug disposed in the lumen, wherein the plug defines an angled surface permanently attached to and extending from a surface of the lumen opposite the port to a position at or adjacent a proximal portion of the port and wherein the plug comprises a fluid passage configured for the passage of fluid through the lumen of the dilator;
• and
• introducing both the dilator and the catheter into a vessel of the patient along a portion of the first guide wire.