Closed tracheal suction systems (CTSS) are currently being used to minimize complications associated with endotracheal suctioning. Advantages of CTSS include improved oxygenation, decreased clinical signs of hypoxemia, maintenance of positive end-expiratory pressure, infection control, convenience, cost, and reduced patient anxiety. Some concerns related to use of CTSS include autocontamination, decreased effectiveness, difficult to use, excess negative pressure, and airway trauma. Strategies for reducing these and other concerns are shared. Recommendations for nursing practice and nursing research are discussed

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