Kennedy Terminal Ulcers

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Specializes in Hospice and Palliative Care, Family NP.

Have any of you had much experience with this type of ulcer? The Kennedy Termial Ulcer?

I had a patient I admitted a few weeks ago. He was in a LTC facility. This man develped the worst KTU's I have ever seen.

My question is this, Have you ever seen them anywhere other than the coccyx? The reason I ask is, he had area on each heel, that came on within hours, they were purple and looked just like big blood blisters. His entire heels were covered! They looked exactly like the one on his coccyx. I swear they were KT ulcers. Could it be they were?

Thanks,

Cindy

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This is the first time I had seen that term used. I had to do a search on it and read about it here:

http://www.kennedyterminalulcer.com/

After reading about it, I don't see why the theory behind it couldn't apply to heels as well.

In retrospect, I think I have seen quite a few on the coccyx but I can't say I remember any that came on quickly on the heel.

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Specializes in Hospice and Palliative Care, Family NP.
This is the first time I had seen that term used. I had to do a search on it and read about it here:

http://www.kennedyterminalulcer.com/

After reading about it, I don't see why the theory behind it couldn't apply to heels as well.

In retrospect, I think I have seen quite a few on the coccyx but I can't say I remember any that came on quickly on the heel.

I am aware of this site and have actually printed it out and used it for educating LTC personnell. I just have never seen them on a heel, but I swear, that is what it looked like. I have emailed Karen Kennedy and asked this same question. I'll post as soon as I hear back from her or whoever answers her email!

We learned about KTU about two years ago. We had an amazing ET nurse who provided wound care to many of our hospice patients. She did an inservice on them. After learning about them, we realized we had been seeing them but did not know what they were.

Cindy

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Specializes in med/surg, hospice.

I have had two patients that developed them. The second one broke out with a them all over her back (including her coccyx), her legs and (yep) her heels. They looked like giant purple/black blood blisters that came up overnight. Horrifying for the family (she was a homecare pt). It is a perfusion issue and nothing you can do to prevent them. I know this will sound odd but if you will soak several 4x4 gauze c milk of mag, place them on the ulcers and cover them tightly with plastic wrap taped down, they will debride overnight rather than fulminating.

The most I have ever heard of anyone living with these is four days. Both of my pts died within four days or less.

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at best, all we can do is try and prevent further necrosis and relieve any associated pain.

i learned a couple of yrs ago about them being called kennedy ulcers but have been seeing them for much longer.

and, we knew a long time ago that treating them in hopes of healing, was also futile.

some form of abt ung and controlling drainage, is how we dress them.

leslie

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Specializes in Hospice and Palliative Care, Family NP.
I have had two patients that developed them. The second one broke out with a them all over her back (including her coccyx), her legs and (yep) her heels. They looked like giant purple/black blood blisters that came up overnight. Horrifying for the family (she was a homecare pt). It is a perfusion issue and nothing you can do to prevent them. I know this will sound odd but if you will soak several 4x4 gauze c milk of mag, place them on the ulcers and cover them tightly with plastic wrap taped down, they will debride overnight rather than fulminating.

The most I have ever heard of anyone living with these is four days. Both of my pts died within four days or less.

Milk of Mag soaked 4X4's! I will have to try that.

Your right, the heels looked just like you described. I had never seen heels so ugly. They looked just like what comes on the coccyx.

Thanks for the tip! I added it to my book of hospice tricks!

Cindy

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Specializes in ICU.

Just had to add that I have had for the past few days, a patient who developed a Kennedy Ulcer overnight on her sacrum / coccyx that was GIGANTIC! It was 15cm x 15cm and classic butterfly shaped.

She also had AWFUL heel ulcers that were new; they were soft, black, looking very much like a "blood blister".

Her heels were completely offloaded and I had even taken any bedcoverings off her feet so that NOTHING could apply pressure....well, within hours, these crazy ulcers were developing on the tips and tops of toes!, then tops of feet!

Back for another day with her tomorrow. I've been trying for almost 2 days to educate our MD's about this crazy phenomenon.

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Been a Hospice RN 8 years.. never ever heard that term before.. Not here on the west coast anyway.

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Been a Hospice RN 8 years.. never ever heard that term before.. Not here on the west coast anyway.

Interesting the regional differences, I'm in the PacNW & have used the term for years (pre- original post).

I did a bunch of inpatient hospice work over the spring & summer, it's both fascinating and horrifying to watch them develop. This facility used a combination of either Alevyn or DuoDerm to cover them, always much larger than was needed to cover the wounds and never changed unless if fell off. Just cutting off the air to the lesions and providing some padding seem to do a lot to lessen or even relieve the discomfort.

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OH I definitely know what they are.. just not the "term". I have seen them develope over night on terminal patients who are transitioning.. and if the transition is long.. these ulcers have been know to just erupt. It's really hard on family as they think they "are doing something wrong" when this does happen on a home patient.

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I am so glad to read this thread. I visited my patient on Tuesday and her feet were perfectly fine. On Friday, there was a 5 cm Stage II with yellow exudate and purulent drainage on the inner aspect of her heel. The location of the wound was totally inconsistent with any actual pressure point. Her caregivers are exceptionally carefule and her feet and ankles are kept well cushioned.

I am extremely vigilant in my skin and foot assessments. . . it's just something I'm really tuned in to. I couldn't imagine that a wound could appear and be SO extensive in so brief a period of time. I have been pondering this situation wondering how/if I had missed something on the Tuesday visit. I feel much better about it after perusing this thread and the link.

I sincerely appreciate this information being posted on this topic as I had never heard of the KTU.

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Specializes in Cath Lab/ ICU.
Been a Hospice RN 8 years.. never ever heard that term before.. Not here on the west coast anyway.

I'm in the west as well, former ICU nurse here, and we've called them KTU for years.

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