[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Critical care](https://durgical.com/en/nursing/areas/critical-care/) › Basic care of the ICU patient: eyes, mouth, skin, devices and device-related pressure injuries

# Basic care of the ICU patient: eyes, mouth, skin, devices and device-related pressure injuries

- Safe practice

ICU patients cannot blink, swallow or move as usual: scheduled eye, mouth and skin care, and checking under every device, prevent harm.

Updated Nov 13, 2026

## Key points

- Check eyelid closure in every sedated or paralysed patient: incomplete closure is the main risk for exposure keratopathy.
- Lubricating gels or ointments with lid closure (film or moisture chamber) protect the cornea better than saline alone.
- Change gloves between mouth care and eye care, and use a separate swab for each eye.
- Endotracheal and nasogastric tubes and NIV masks cause most device-related pressure injuries.
- Device injuries take the shape of the device and appear at unusual sites: nose, lips, ears, neck, chin.

## What it is

Sedation, paralysis, tubes and immobility take away the body's own protection. Eyes that do not close dry out and ulcerate; lips and mouth under a tube develop pressure injuries; skin under tubes, masks, collars and sensors breaks down in the shape of the device. Basic care is scheduled, documented and checked like any other ICU intervention. This page covers eye care, care of the mouth and lips around the tube, and device-related pressure injuries; routine hygiene, pressure injury prevention, and the endotracheal tube and VAP bundle have their own pages.

## What it requires

- Eye risk factors: sedation, neuromuscular blockers, incomplete lid closure, prone position, high PEEP, conjunctival swelling, low consciousness.
- Devices that cause pressure injuries: endotracheal tube and its ties, tracheostomy, nasogastric tube, NIV mask, cervical collar, urinary catheter, arterial catheter, splints, anti-embolism stockings.
- Risk is higher with older age, oedema, long ICU stay, mechanical ventilation and vasopressors.

## Components

- Eyes: assessment of lid closure, lubrication, lid closure aids, lid hygiene.
- Mouth and lips: oral care per the VAP bundle, checks of lips and mouth under the tube.
- Skin under devices: inspection, padding, size, securement, reassessment of need.

## How it is applied (and why)

- Assess the eyes on admission and at each set time (closure, redness, discharge, cloudy cornea): early damage is silent in a patient who cannot complain.
- Clean lids gently with sterile saline or water-moistened gauze, a separate swab for each eye: it removes debris without spreading germs.
- Apply the ordered lubricant and keep the lids closed with film or a moisture chamber if they do not close: it prevents corneal ulcers.
- In prone position, keep the head neutral and avoid any pressure on the eyes: pressure and swelling injure the cornea.
- Inspect the lips and mouth under the tube at each oral care: the tube causes pressure injuries there.
- Choose the right size of mask or device and secure it without excess tension: tight fixation causes injury.
- Check the skin under every device at least daily, more often in high-risk patients, and pad where the protocol allows.
- Move or reposition devices as the protocol sets, and loosen fixation when oedema appears.
- Ask each day whether every device is still needed: removing a device removes its risk.

## In nursing practice

- Red, sticky or cloudy eyes in a sedated patient can be infection or an ulcer: report the same shift.
- Routine antibiotic eye drops are not used for prevention; treatment is given only when infection is found.
- A device-shaped mark that does not fade is a pressure injury: document it with its site and size.
- Suctioning can carry mouth bacteria to the eyes: keep the eyes covered and clean.

## Common mistakes

- Taping the lids without lubrication, or pressing on the eyeball.
- Using the same gloves or swab for the mouth and the eyes.
- Looking only at the sacrum and heels and forgetting the skin under the tube, mask, collar and sensors.
- Leaving a device in place because «it might be needed».

## Test yourself

Think of the answer, then tap the question to see it.

## What is the main risk factor for exposure keratopathy in ICU patients?

Incomplete closure of the eyelids, often due to sedation or neuromuscular blockers; mechanical ventilation also raises risk.

## What protects the cornea of a sedated patient best?

Lubricating gel or ointment with lid closure using film or a moisture chamber, on schedule; saline alone is not enough.

## Which devices cause most device-related pressure injuries in the ICU?

Endotracheal tubes and their ties, nasogastric tubes and non-invasive ventilation masks.

## How do device-related pressure injuries differ from other pressure injuries?

They often take the shape of the device and appear at unusual sites such as the nose, lips, ears, neck or chin.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/basic-care-of-the-icu-patient-eyes-mouth-skin-devices-and-device-related-pressur/)

## Connections

## Related 5

- [Bed bath, oral care and hygiene of the dependent patient](https://durgical.com/en/nursing/bed-bath-oral-care-and-hygiene-of-the-dependent-patient/)
- [Preventing pressure injuries: risk scales, repositioning and skin care](https://durgical.com/en/nursing/preventing-pressure-injuries-risk-scales-repositioning-and-skin-care/)
- [Endotracheal tube care and VAP prevention: securing, cuff pressure, tube depth, oral care, head of bed and unplanned extubation](https://durgical.com/en/nursing/endotracheal-tube-care-and-vap-prevention-securing-cuff-pressure-tube-depth-oral/)
- [Prone positioning: the team, the turn, protecting tubes, eyes and pressure points](https://durgical.com/en/nursing/prone-positioning-the-team-the-turn-protecting-tubes-eyes-and-pressure-points/)
- [The patient on neuromuscular blockers: sedation first, train-of-four, eye care and skin](https://durgical.com/en/nursing/the-patient-on-neuromuscular-blockers-sedation-first-train-of-four-eye-care-and/)

## Related conditions 1

- [Pressure injury (pressure ulcer)](https://durgical.com/en/conditions/pressure-injury/)

[← All of nursing](https://durgical.com/en/nursing/)

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Ocular Surface Disorders in ICU Patients: Evidence-Based Nursing Prevention Strategies (Ni W, Jiao X)](https://pmc.ncbi.nlm.nih.gov/articles/PMC12743487/) (Translational Vision Science & Technology, PubMed Central, 2025); [Medical Device-Related Pressure Injuries: an integrative literature review (Galetto SGS et al.)](https://www.scielo.br/j/reben/a/BzhBLh3dBvdFKdHZWG4TLWG/?lang=en) (Revista Brasileira de Enfermagem, SciELO, 2019); [Neuromuscular blocking drugs in the critically ill (Welhengama C, Hall A, Hunter JM)](https://pmc.ncbi.nlm.nih.gov/articles/PMC8212158/) (BJA Education, PubMed Central, 2021).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/nursing/basic-care-of-the-icu-patient-eyes-mouth-skin-devices-and-device-related-pressur/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/basic-care-of-the-icu-patient-eyes-mouth-skin-devices-and-device-related-pressur/