Clinical Problem: Forty ventilator dependent residents at high risk on the Braden scale for friction/shear. Their ages ranged from 19 to 87 years of age. Inspite of a the use of a liquid film barrier*, some residents continued to show signs of deep tissue injury. Mushiness and blistering were the most common notations on 17/40 residents. Description of Past Management: Pillows or anti-fixation devices were used on all residents as well as a liquid film barrier* applied qod. Current Clinical Approach: All residents were assessed by either the ET or the wound nurse qd for eight days. The right heel was used for the medical grade cyanoacrylate** and the left heel for the liquid film barrier*. The signs of skin breakdown measured were 1) shadowing of the skin 2) bogginess 3) pink/redness 4) blistering 5) actual open lesions(s). The sheen of the product along with touch was used for defining if the product was still intact as both are colorless and clear. Patient Outcomes: With the liquid film barrier*, 31 needed reapplication within one day, 4 within two, five within three and one resident CTB within a day of study initiation. With the medical grade Cyanoacrylate** 0 needed reapplication within one or two days, three within 3 days, thirty five within 7 days, and again, one resident CTB. Of the 17 with intial breakdown, 15 showed signs of bogginess and/or shadowing with the liquid film* over a period of eight days and 2 heels resolved. With the medical grade cyanoacrylate**, thirteen of 17 resolved their bogginess/shadowing within three days and 4 within five days. Conclusion: The medical grade cyanoacrylate** provided a time-saving effective method of resolving early skin breakdown on the heels. * Cavilon lollipop , 3M ** Liquishield , Medlogic Global LLC