Where do you place your hands for Cardiopulmonary Resuscitation (CPR)?

Hand Placement for CPR

For effective CPR, place the heel of one hand on the center (middle) of the victim's chest (the lower half of the sternum) and the heel of the other hand on top of the first so that the hands are overlapped. 1

Proper Hand Position Technique

The correct hand placement for CPR involves these specific steps:

1. Locate the sternum (breastbone):

   • Kneel beside the victim
   • Run your index and middle fingers up the lower margin of the ribcage to find the notch where the ribs join (xiphoid process)
   • Place your middle finger in this notch and your index finger on the sternum above it

2. Position your hands:

   • Slide the heel of your second hand down the sternum until it reaches your index finger
   • This places the heel of your hand in the middle of the lower half of the sternum
   • Remove your first hand and place it on top of the second hand
   • Interlock your fingers to ensure pressure is not applied over the ribs 1

3. Body position for effective compression:

   • Lean well over the victim
   • Keep your arms straight
   • Press down vertically on the sternum 1

Compression Technique

When performing chest compressions:

• Depth: Depress the sternum 4-5 cm (2 inches) for an average adult 1
• Avoid excessive depth: Do not compress greater than 6 cm (2.4 inches) 1
• Rate: Perform compressions at a rate of 100-120 per minute 1
• Allow complete chest recoil: Avoid leaning on the chest between compressions 1, 2
• Minimize interruptions: Keep pauses in chest compressions as short as possible 1

Important Considerations

• Hand dominance: While some research suggests a trend toward improved compression quality when the dominant hand contacts the sternum, this difference is not statistically significant 3. Either hand can be used effectively.

• Complete chest recoil: Ensure complete chest wall decompression between compressions, as this improves hemodynamics by generating negative intrathoracic pressure that draws venous blood back to the heart 2.

• Avoid incorrect placement: Studies show that compressing too high on the chest (at the inter-nipple line) often results in compression of the ascending aorta or aortic root rather than directly over the left ventricle 4. This supports the recommendation to compress the lower half of the sternum.

• Firm surface: Perform CPR on a firm surface with the victim in the supine position whenever possible 1.

Common Pitfalls to Avoid

1. Improper hand position: Placing hands too high, too low, or off-center on the chest
2. Incomplete chest recoil: Leaning on the chest between compressions
3. Incorrect compression depth: Either too shallow (ineffective) or too deep (risk of injury)
4. Interrupted compressions: Taking too long for pulse checks or ventilations
5. Fatigue: Not switching compressors every 2 minutes when multiple rescuers are available 1

By following these guidelines for proper hand placement and compression technique, you can maximize the effectiveness of CPR and improve the chances of survival for cardiac arrest victims.