When performing DN the chiropractor/osteopath must ensure the welfare of the patient, him or herself and the third party. Professional judgement must be applied when selecting DN treatments.

DN should be applied within the scope of practice of a Chiropractor in South Africa, with consideration of their training and experience.

The chiropractor should ensure that their skills are appropriate and confined to the areas in which they have received training. Should they wish to extend these skills additional training must be sought.

DN should only be utilised once a comprehensive chiropractic examination of the patient has been undertaken, and it has been established that it is a suitable treatment for the patient and the condition.

Informed consent must be obtained prior to using DN techniques. The patient should be appraised of potential adverse effects and possible risks. In addition the patient should be informed that during the procedure that they must not sneeze, cough or move, and that should they need to they must inform the practitioner so that the needle may be withdrawn [19]. In addition, any advice necessary regarding post-treatment considerations must be given to the patients such as post-needling soreness.

Clear documentation of the DN utilised on a patient must be recorded in the patients file, along with any adverse events that may have occurred [30].

Never insert the needle to the hub as this is an area of weakness and the needle may break at this point [30].

The utilisation of DN should be done with due consideration to evidence informed practice i.e. consultation of the scientific literature, the patient’s beliefs and goals for the treatment and due clinical reasoning.

Only sterile, single use, disposable, solid filament needles must be used.

Where possible always position the patient in the recumbent position to avoid psychogenic syncope [30].

Hygiene and waste disposal guidelines must be adhered to.