Endotracheal suctioning (ETS) is a necessary practice carried out in intensive care units. In involves the removal of pulmonary secretions from a patient with an artificial airway in place. All intensive care nurses should be aware when performing this intervention of the potential hazards a patient is exposed to, and should endeavour to prevent or minimize these. This literature review explores the criteria available to indicate a need for ETS and discusses the potential adverse effects of ETS and how these can be avoided during the procedure. The question is raised as to the frequency with which the procedure should be performed. The current dilemma facing nurses is the overwhelming view that ETS should be performed only when indicated as necessary by assessment, to minimize the exposure of the patient to the hazards of ETS, but also recognition that ETS is a necessary procedure to maintain a patent airway and clear secretions. As nurses are accountable for all aspects of their practice, they need to be able to make an informed choice about the frequency with which ETS is performed. It is hoped that this review will increase nurses' awareness of the potential hazards surrounding ETS, and enable them to question their practices regarding their ability to assess individual patient needs and determine the frequency with which ETS should be performed.