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).
