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Once you've punctured the spinal canal space during lumbar puncture, the following tips can be used to improve the rate of cerebrospinal fluid (CSF) flow, should it be suboptimal:
- Ask the patient to cough or bear down as in the Valsalva maneuver.
- Ask an assistant to intermittently press on patient's abdomen.
- Turn the spinal needle 90 degrees such that the bevel is cephalad.
- Use a larger diameter spinal needle (increases risk of post-lumbar puncture headache).