Implementing clinical guidelines is crucial in order to maintain the safety of all patients. Although most of the evidence suggests not to use NSI when suctioning, there are various limitations to the studies done such as small sample size, settings, inconsistencies in data collection, or not enough or outdated research clinical trials, which calls for further research studies. Therefore, extensive clinical trials are recommended to effectively determine if NSI with suctioning an artificial airway is indeed harmful, and adherence to national clinical guidelines should be strictly enforced nationwide for all hospitals to include in their standardized protocol to not use NSI with suctioning.