Kennedy Terminal Ulcer: What You Need to Know
What is a Kennedy Terminal Ulcer (KTU)?
A KTU is an unavoidable skin breakdown or skin failure that occurs as part of the dying process.1
What does a KTU look like?
The KTU is described as a pear-, butterfly-, horseshoe-, or sometimes irregular-shaped red/yellow/black ulcer, similar in appearance to an abrasion or blister, that may occur suddenly.2
Where do KTUs usually appear?
Kennedy Terminal Ulcers have been known to appear in the sacral/coccygeal area, as well as on the heels, posterior calf muscles, arms, and elbows.3
How does a KTU progress?
Kennedy Terminal Ulcers come on quickly and progress rapidly, often within hours.1 The blister roof may be very fragile and even gentle cleansing may change the skin surface from intact to a fairly large open wound. A KTU may darken quickly before demarcating within days; it has the characteristics of early deep tissue injury and can progress rapidly to a Stage II, Stage III, or Stage IV ulcer (see Figures 1-2). Sometimes the surrounding tissue is soft or loose beneath the surface. Time is a key factor.4
What is the history behind the KTU?
The skin breakdown in the sacral/coccygeal area was first noted by Karen Lou Kennedy-Evans and other health care workers at the Byron Health Center, an intermediate care facility in Fort Wayne, IN, in 1983. The ulcer occurred despite preventive measures. Skin deterioration progressed rapidly, even in the course of a single day. Caregivers and family members were surprised at the sudden onset; Byron staff noted this type of ulcer heralded impending death.1
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RELATED CONTENT
Kennedy Terminal Ulcer: the “Ah-Ha!” Moment and Diagnosis
Notes on Practice: Elder Abuse or Kennedy Terminal Ulcer?
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References
1. Schank J. Kennedy Terminal Ulcer: the “Ah-Ha” Moment and Diagnosis. Ostomy Wound Manage. 2009;55(9):40-44.
2. Kennedy KL. The prevalence of pressure ulcer in an intermediate care facility. Decubitus. 1989;2(2):44–45.
3. Langemo DK, Brown G, Skin fails too: acute, chronic, and end-stage skin failure. Adv Skin Wound Care. 19(4);206–211.
4. Bryant RA. Pressure ulcer prevention summit: Minnesota’s response to adverse health events. Available at: www.mnpatientsafety.org/files/tools/PU_Summit. Accessed September 8, 2009.
