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This chapter describes the legal landscape related to Miranda rights and waivers, as well as the relevant research literature regarding Miranda waiver decisions. The chapter identifies factors related to Miranda rights comprehension and waiver and emphasizes research addressing interrogations of youth and their abilities to provide a valid waiver. Research has identified that suspect-related factors, including age, IQ, and psychosocial maturity, as well as structural factors, such as the length, reading level, and content of the Miranda warnings, are related to Miranda comprehension and waiver decisions. The chapter also discusses the legal standard for judicial decisions related to the admissibility of confessions following Miranda waivers, as well as the factors that judges typically consider when making such decisions. Because research demonstrates that many suspects struggle when making Miranda waiver decisions, we conclude by making policy recommendations and identifying areas in which future research is needed.
To determine the overall and per-day risk of complications of short peripheral intravenous (PIV) catheters placed for indefinite periods.
Design:
During 5 months, general pediatric patients receiving intravenous therapy through short PIV catheters were monitored. Patient and catheter characteristics were recorded, complications were noted, and rolled semiquantitative cultures of removed catheters were performed. Major endpoints were infection and phlebitis. Per-day risk of complications and catheter colonization (>15 colony-forming units) were calculated.
Setting:
University children's hospital.
Patients:
General pediatric ward inpatients with PIV.
Results:
We studied 642 Teflon catheters in place >24 hours (mean, 3.7 days) in 525 patients. There were no cases of catheter sepsis (0%; 95% confidence interval [CI95], 0%-0.6%), one possible insertion-site infection (0.2%; CI95, 0.004%-0.9%), and seven cases of phlebitis (1.1%; CI95, 0.4%-2.3%). Catheter colonization occurred in 92 (26%) of 348 catheters cultured. Neither the per-day risk of phlebitis nor of catheter colonization increased significantly with placement >3 days.
Conclusion:
Current guidelines recommend replacement of PIV catheters in adults within 2 to 3 days; no recommendations are made for children. Our findings and those of others indicate that the overall risk of PIV catheter complications in children is extremely low and would not be reduced substantially by routine catheter replacement.
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