Iranian Journal of Nursing and Midwifery Research1735-906629520240910590595EN1. Medical-Surgical Nursing Department, Faculty of Nursing, Suez Canal University, Ismailia, Egypt, 2. Department of Medical and Surgical, College of Nursing, Qassim University, Buraidah, Saudi Arabia,1. Medical-Surgical Nursing Department, Faculty of Nursing, Suez Canal University, Ismailia, Egypt, 2. Department of Medical and Surgical, College of Nursing, Qassim University, Buraidah, Saudi Arabia,1. Medical-Surgical Nursing, Faculty of Nursing, Damanhour University, Egypt, 2. Medical-Surgical Nursing Department, Ibnsina National College for Medical Studies, Saudi ArabiaAnaesthesia and Pain Management Department, Faculty of Medicine, Suez Canal University, EgyptPulmonology Unit Internal Medicine Department, Faculty of Medicine, Suez Canal University, Egypt,1. Medical-Surgical Nursing Department, Faculty of Nursing, Port Said University, Egypt, 2.Department of Medical and Surgical, College of Nursing, Qassim University, Buraidah, Saudi Arabia,2024101520241015<p><strong>Background: </strong>Endotracheal Tube Suctioning (ETS), which involves either an open or closed suctioning system, is a crucial practice for mechanically ventilated patients. The nursing practice of airway suctioning is inevitable. This study was designed to compare the intensive care nurses’ performance of open versus closed endotracheal suction on critically ill patients in Ismailia City.</p><p><strong>Materials and Methods: </strong>A non‑participant structured observational study design was conducted on a convenient sample (N = 63) at intensive care units at a teaching hospital through March and August 2022 to evaluate how nurses practice different procedures in open suctioning compared with the closed suctioning system of Endotracheal Suction (ES) through a 32‑item structured checklist. Additionally, authors compared their levels of knowledge in both suctioning systems.</p><p><strong>Results: </strong>Approximately 75% and 65% of the study participants had a satisfactory level of knowledge about the open system compared with the closed system, respectively. The total percentage of patients who achieved a satisfactory level of practice was 72% for the open‑system group, compared with 56% for the closed‑system group. Overall, there were significant differences between total nurses’ performances in the open‑system and closed‑system systems. Independent sample t‑tests revealed a statistically significant correlation between overall nurses’ performance in both systems (t = 6.04, <em>p </em>&lt; 0.001).</p><p><strong>Conclusions: </strong>The findings revealed significant differences in nurses’ performance between open and closed‑system suctioning. The researchers recommend in‑service‑led training programs to improve nurses’ performance, and other studies with larger sample sizes should be supported.</p>http://ijnmr.mui.ac.ir/index.php/ijnmr/article/view/2157http://ijnmr.mui.ac.ir/index.php/ijnmr/article/download/2157/70707725