Enhancements to the design of lumbar puncture needles can confer benefits to patients in terms of reducing complications and can also contribute to reducing drug errors. The newer ‘non‐cutting’ needles, such as the Sprotte and Whitacre types, cause fewer post‐lumbar puncture headaches (PLPHs) than the older ‘cutting’ needles, such as the Quincke type (Doherty and Forbes [50], Engelborghs et al. [56]). This is because the vertically aligned dural fibres are split and parted instead of being cut, thus allowing some degree of dural self‐sealing. In the same manner, thinner‐gauge needles create less of a CSF leak and further reduce the occurrence of PLPHs (Engelborghs et al. [56], NPSA [171]). It is important to be aware of alerts in relation to equipment problems, such as an incorrect needle size supplied in certain packs (MHRA [146]).

Depending on the patient's condition and the reason for the lumbar puncture, various observations and recording tools should be used. As a baseline, the patient's vital signs must be recorded before and after the procedure and documented on an observation chart. If the patient is being investigated for a neurological problem, then the inclusion of pre‐procedural Glasgow Coma Scale (GCS) assessment is advised. In all cases, neurological observations, including GCS and pupillary response, should be recorded on a neurological observation chart following the procedure. The patient should be monitored for headache and backache and the puncture site should be inspected, particularly if there have been fluctuations in the neurological observations (Chernecky and Berger [32], Doherty and Forbes [50], Pagana and Pagana [177]).

Preparation includes advising the patient to empty their bowels and bladder to ensure comfort during the correct flexed (knee‐to‐chest) position that the patient must assume during the procedure. This position is required to increase the space between adjacent vertebral spines to allow for the passage of the needle (Chernecky and Berger [32], Doherty and Forbes [50], Lindsay et al. [126], Pagana and Pagana [177]).

Skin disinfection is of extreme importance to prevent serious spinal infection. A chlorhexidine or equivalent antiseptic is the most effective solution in this regard, but it must be allowed to air dry completely to prevent the neurotoxic chlorhexidine from coming into contact with neural tissue (Doherty and Forbes [50]).