Is a Kennedy Terminal Ulcer a pressure injury? What are the main characteristics?

A Kennedy Terminal Ulcer is a pressure injury that develops on residents as they are dying. The skin is the largest organ. Thus, the skin undergoes organ failure just like other organs, such as the heart, lungs, kidneys and liver.

Failure of the skin can be indicative of what is going on inside the body. As people are approaching the dying process, the organs begin to slow down and function less efficiently. One idea is the skin may show effects of pressure more rapidly than normal, secondary to a blood perfusion problem exacerbated by the dying process. Therefore, typical interventions to prevent pressure ulcers may now not prevent tissue damage.

A Kennedy Terminal Ulcer tends to have a sudden rapid onset, developing in a matter of hours. Clinicians have reported the ulcer presenting in the few hours between morning and afternoon skin check. It usually presents on the sacrum but can appear on any bony prominence. Typically, the area can have colors of red, yellow, black or purple.

Clinicians have described the area as if someone had colored the skin with a black or purple marker. It usually starts out superficially as a blister, or it may look like an abrasion and can rapidly progress to a Stage 3 or 4. It also can progress in size in a matter of hours. The shape has regular edges and can be like a pear, butterfly or horseshoe rather than mimicking the bony prominence.

Treatment of a Kennedy Terminal Ulcer is the same as for any other pressure injury with the same characteristics. The majority of these ulcers do not get better. However, the phenomenon has been known to be reversed with aggressive life-saving interventions, such as IVs, tube feedings, surgical debridement, antibiotics and other appropriate modalities.