EFFECT OF WARM WATER COMPRESS THERAPY ON THE INCIDENCE OF HYPEREMIA IN PHLEBITIS PATIENTS AT THE INPATIENT WARD

This study aims to determine the effect of warm water compress therapy on the incidence of hyperemia in 40 patients with phlebitis at the Inpatient Installation of H. Hasan Basry General Hospital Kandangan. Research method used quasi-experimental with two group; control and intervention. The control group was untreated phlebitis, while the intervention group was a phlebitis patient treated with warm water compresses. Data collection was collected by measuring the redness diameter before and after warm compress therapy. The result showed that the mean of intervention group diameter before treatment 49.3 mm and after treatment 40.2 mm. The mean diameter of control group before treatment 48.1 mm and after treatment 46.4 mm. The mean diameter of intervention group was decreased 9.1 mm and 1.7 mm in the control group. Statistically result test show that there was a significant difference of mean hyperemia diameter between intervention and control group (p<0.05). Statistically result test also shows that there was a significant difference of mean hyperemia between preand post-treatment with warm water (p<0.05). It was concluded that the warm compress therapy could decreased the incidence of hyperemia in phlebitis patients.


INTRODUCTION
Phlebitis is an inflammation of a vein.Phlebitis is an infection of microorganisms during hospitalization, with clinical manifestations appearing at least 72 hours. 1 Phlebitis is caused by chemical irritation, mechanical factors and bacterial agents that often occur as a complication of intravenous therapy.Patient will get intravenous therapy using infusion in all health care settings such as acute care, emergency care, ambulatory care and home health care.Approximately more than 60% of hospitalized patients received intravenous therapy and were at risk of developing phlebitis. 2ymptoms of phlebitis are pain, swelling, redness, induration and palpable in the vein attached to catheter.The most common visual response is redness (hyperemia) of the skin at the intravenous site. 7he incidence of phlebitis (5%) becomes one of the indicators of hospital service quality with the standard set by The Infusion Nursing of Practice.In Indonesia there is no definite number of the phlebitis prevalence, but some studies indicated that the incidence of phlebitis was still high.4 Depkes RI Data in 2013 showed that the incidence of phlebitis in Indonesia was 50.11% in Public Hospital and 32.70% in Private Hospital.Nurdin 5 et al stated that the incidence of phlebitis in Prof. Dr. Aloe Saboe Hospital Gorontalo was 7.51%.The incidence of phlebitis in the hospital ward at Cipto Mangunkusumo Hospital Jakarta was 11 cases (10.1%) of 109 patients receiving intravenous fluid with onset 2 days after insertion.Similarly, the incidence of phlebitis at AR Bunda Prabumulih Hospital in 2014 was 12% .6,7 Previous study conducted at Brigjend H. Hasan Basri Hospital Kandangan found phlebitis incidence was 47 (18.5%) of 254 patients.This indicated that the incidence of phlebitis was still common in the hospital.The initial study on 5 patients with phlebitis showed that all of them experienced a reddish reaction (hyperemia).In addition, there was no standard operational procedure for phlebitis in Brig.Hasan Basri Hospital Kandangan.
Phlebitis can be treated pharmacologically and nonpharmacologically. Non-pharmacological treatments include skin stimulation in the form of warm compress therapy. 2 It is independently done by the nurse, economical, and no side effects.Doengos 8 stated that warm compress can cause vasodilation of blood vessel and increase oxygen circulation in the hypoxia area, thereby decreasing the inflammatory reaction. 9 If phlebitis is not treated early, it can caused sepsis with the most common symptom of pain and hyperemia.The incidence of phlebitis in the ward is often ignored by the nurse.The nurse simply replaces the catheter, but does not provide adequate care to treat the phlebitis.Warm compress therapy can be used as an alternative care of nursing for the treatment of symptoms of phlebitis, especially hyperemia.This study will examine the effect of warm compress therapy on the incidence of hyperemia in patients with phlebitis.

RESEARCH METHODS
The design of this study was quasiexperimental with two groups of pretestposttest design.Study group was given intervention, while the control group was not, with each was measured twice, before and after treatment.
The samples were all phlebitis patients in the Inpatient ward of H. Hasan Basry Kandangan General Hospital aged 17 years to 44 years, not in chemotherapy or postoperative patients.The number of samples were 40 people, with each group was 20 people.
Data was collected by measuring the diameter of hyperemia before and after warm compress therapy using a ruler.
The data obtained were tested using an unpaired T test to know the effect of warm compresses on hyperemia in the intervention and control groups, and paired T test to compare changes in the hyperemia reaction of intervention group before and after treatment.

RESULTS AND DISCUSSION
The sample were 40 respondents, with characteristics presented in table 1.The diameter of hyperemia in the intervention group before and after treatment is shown in Figure 1.Warm compress therapy can reduce the diameter of hyperemia in phlebitis patients.In addition, the mean comparison of hyperemia diameter in the control and intervention groups was presented in Figure 2. The results in Fig 2 showed that the diameter of hyperemia in the control group is lower than the intervention group.The results were then tested for data distribution normality.It showed that the data was normal in distribution (table 2).Due to normal distributed data, the statistical analysis used paired and unpaired T test.It showed that the mean ratio of hyperemia diameter between the control group and the intervention was significantly different ( p <0.05) (Table 3).The mean ratio of intervention group hyperemia diameter before and after treatment was significantly different (p <0.05) (table 3).The results showed that the reaction of hyperemia in patients with phlebitis in this study reduced after the patient was given warm water compress.It is supported by the results of Temple and Johnson 10 which stated that water was able to help the process of tissue epithelization which accelerate the process of wound healing without causing negative impact on patients.This was proven when a warm compress treatment was given for 2 days.There was no side effects that are detrimental to the respondent.In addition, Doengos 8 et al also proved that warm compresses can cause vasodilation of blood vessels and increase oxygen circulation in the hypoxia area also decrease the intensity of pain and the reaction of hyperemia.Kozier 9 stated that hot or cold compresses produce physiological changes in tissue temperature, blood vessel size, capillary blood pressure, capillary surface area for fluid and electrolyte exchange, and tissue metabolism.
. Water is usually used for hydrotherapy, solvents, and wound cleansers.Besides it's ability to help heal wounds, it is also easy and cheap to provide.In addition, warm water compresses can be provided without having to make a prescription in advance.Warm water also helps to reduce the pain caused by the reaction of hyperemia in patients with phlebitis.This study proved that water in these conditions made the patient to feel more comfortable and decreased the reaction of hyperemia.It is caused by vasodilation and increasing blood circulation on the hyperemia vessel due to warm water.

CONCLUSIONS
Based on the results of the study, it can be concluded that the action of warm water compresses affect the diameter of hyperemia of patients with phlebitis.It proves to be effective in providing comfort and lowering hyperemia reactions due to phlebitis with minimal side effects.Thetefore, warm water compress can be used as an alternative action in patients with phlebitis.Further research may be needed to assess the mechanism of warm water in reducing hyperemia in phlebitis patients.

Figure 1 .
Figure 1.The average diameter of hyperemia in pre-post test on the subject's group

Table 1 .
The Distribution frequency of subject's characteristic

Table 2 .
Normality Test of Pretest and Post Treatment, and hyperemia Changes in study and Control Group