Most mishaps are preventable. Fainting during needling is more common in anxious, fasting or exhausted patients, and is avoided by treating them lying down, using fewer needles and stopping at the first sign of pallor or dizziness. Stuck and bent needles usually follow excessive manipulation or a change in the patient’s position, and are managed by calming the patient and withdrawing along the line of insertion.
Broken needles are rare with modern single-use equipment but must be handled by retrieving the fragment, if necessary surgically. Pneumothorax follows deep needling over the lung fields and presents as sudden chest pain and breathlessness. The rule that prevents most of these events is anatomical: know what lies beneath the point before inserting.