Catheter complications include pneumothorax, accidental arterial puncture, and catheter-related sepsis. The dura is pierced with a needle during a lumbar puncture (spinal tap). An endotracheal tube can puncture the trachea or bronchi and cause subcutaneous emphysema. The procedure is ended by withdrawing the needle while placing pressure on the puncture site. Diagnosis typically involves electromyography and lumbar puncture. This contact caused a right-rear tyre puncture. Serious complications of a properly performed lumbar puncture are extremely rare. Depending on the presumed cause blood tests and lumbar puncture may be useful. The Valsalva maneuver can be used as a means to reduce pain during lumbar puncture. The procedure carries the typical risks of any epidural puncture. Diagnosis of TB meningitis is made by analysing cerebrospinal fluid collected by lumbar puncture. Occasionally a lumbar puncture is also required. It requires a direct lung puncture, or the use of trans-tracheal aspiration. Symonds also described the use of lumbar puncture and xanthochromia in diagnosis. Through these, its sharp ribs can puncture.