Different nurses apply gauzes differently as there is no set standard, an inquest into the suffocation death of a senior was told yesterday.
Wang Keng-kao, 73, who suffered from throat cancer and was forced to breathe through a two- centimeter hole in the trachea - the tube in the neck - died on November 14, 2011.
An autopsy found a piece of gauze blocking his bronchi - the two primary divisions of the trachea that lead into the right and left lungs.
Wang was forced to breathe through the hole after undergoing cancer surgery at Queen Elizabeth Hospital in June 2011. He was transferred for infirmary services to Kowloon Hospital, where he died.
Male nurse Lai Jing-sheung, who changed the gauze on Wang's neck, told the inquest how the procedure is done is a matter of personal preference.
But Wang's son, Brian Wang Ping-wan, said when he visited his father on November 6, he noticed the gauze was secured with tape on all four sides.
The court heard that Lai applied the gauze in a way different from two other nurses. "There is no common practice on how to tape the gauze," he said.
The three nurses who took care of Wang testified that they had to change the gauze several times because it always got soaked with sputum.
However, Queen Elizabeth Hospital's consultant surgeon, Donald Tang Lap-chiu, said the hole should not have been covered, as it was the only channel through which Wang could breathe.
Alexander Chris Vlantis of the Chinese University of Hong Kong's Department of Surgery wrote in the expert opinion report that staff at the Kowloon Hospital had mistakenly assumed Wang's breathing hole to be a wound and covered it with a dressing.
"The care for a tracheal stoma is totally different from that of a tracheostomy wound. A tracheal stoma is never covered with gauze," he said.
Once the gauze becomes soaked with sputum, the patient will find it hard to breathe, he added.
During attempts at inspiring air, Yang suffered from respiratory arrest, during which he was unable to remove the gauze with his hands, he wrote.
Medical officers may have pushed a piece of gauze into the trachea when they inserted a tube into the opening to force air into Wang's lungs.