Smart placement of a mediastinal drain in a neonate who requires a postoperative open sternum

Crowding of the mediastinum after complex cardiac repair procedures in neonates and young children is a frequent problem. To create space, the sternal wound is kept open, commonly with a plastic stent, for later closure. Despite this maneuver, space is still an issue, and appropriate placement of the mediastinal drain can become a challenge. In this article we describe a simple and effective way to eliminate the problem. Holes are made in the sternal stent, and the drain is pulled through these holes. The drain is elevated away from the heart surface and does not contribute to the crowding.