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Try the following (in order): Pull the needle back to just under the skin surface and direct your needle a bit more cranially (one of the more common issues is that entry angles are 'too flat') Pull the needle back to the skin surface and direct your needle a bit more caudally (maybe you were too steep in your initial entry angle) Recheck patient positioning - encourage flexion to open interspinous spaces, ensure shoulders and hips are in line with one another (avoid rotational positioning of the spine) Withdraw the needle from the skin and recheck your entry site to ensure you are a.) in the midline, b.) at the correct L3-L4 or L4-L5 interspinous level, and c.) that the patient is assiduously positioned If, when advancing your needle, you encounter no resistance yet get no fluid

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