PROBLEM Prevention of heel pressure blisters is challenging for immobile orthopedic patients. An increase of skin breakdown in joint replacement patients prompted registered nurses to conduct a study to determine the efficacy of heel pillows versus a durable, cyanoacrylate liquid barrier film - LiquiShieldTM MedLogic UK. METHODOLOGY Patients (n=146) admitted for primary hip (n=55) or knee replacement (n=91) surgery (DRG 209) over a 3 month period. Heel pillows or LiquiShieldTM used exclusively for alternating one-week periods. Heel pillows applied in the post anesthesia care unit. LiquiShieldTM applied once, post-op day one. Daily Skin assessment, Braden Scale, ASA score, heel elevation were recorded by trained Registered Nurse staff. RESULTS Heel pillows=85 patients, LiquiShieldTM =61 patients. Eighteen patients had some signs of skin breakdown (10 heel pillows, 8 LiquiShieldTM). Erythema of the heels occurred on post-operative day one in 6 heel pillows patients and in 5 patients prior to the application of LiquiShieldTM. By post-operative day four there was a 90% decrease of heel erythema for LiquiShieldTM treated patients compared to 42% decrease for heel pillows (p=0.027). No correlation was found between elevated heels or ASA scores and signs of skin breakdown. Costs of using LiquiShieldTM were also significantly lower than the use of heel pillows ($1.68 v $14.50). CONCLUSIONS LiquiShieldTM is a simple and cost-effective technique to prevent skin breakdown related to friction and shear in the orthopedic patients.