Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines chest compressions and rescue breathing to manually maintain blood circulation and oxygen supply to the brain and other vital organs when the heart stops beating. Immediate CPR can significantly increase the chances of survival after a sudden cardiac arrest. For compressions to be effective, proper hand placement is necessary to ensure the force is applied directly over the heart and to minimize the risk of causing injury. This guidance details the correct placement and technique for CPR across different age groups.
Locating the Correct Position for Adults
The target area for chest compressions on an adult is the lower half of the sternum, which runs down the center of the chest. This specific location is directly above the heart, allowing compressions to generate the most effective blood flow. Identifying this spot is the first step in delivering high-quality CPR.
A common and quick way to locate this area is to place the heel of one hand in the center of the chest, roughly along the imaginary line connecting the nipples. The compression point should be on the breastbone, avoiding the very bottom tip where the ribs meet. This lower half of the sternum provides the most stable surface for applying the necessary force.
Placing the hands too high on the sternum or too far to the side over the ribs can reduce the effectiveness of the compressions. Focusing on the center ensures the applied pressure is channeled to the area that will best circulate oxygenated blood. It is important to ensure the person is lying on a firm, flat surface before attempting to locate the position.
Hand Technique and Body Mechanics
Once the correct spot on the adult’s sternum is located, the next step is to arrange the hands and body to deliver consistent force. Place the heel of one hand directly on the lower half of the sternum. Then, stack the heel of the second hand directly on top of the first hand.
The fingers of both hands should be interlaced or lifted up and kept off the chest wall. This technique ensures that the force is concentrated solely through the heels of the hands and onto the sternum, preventing pressure from being applied to the ribs. Applying pressure to the ribs increases the risk of fracture, which can complicate the person’s recovery.
Body positioning is just as important as hand placement for achieving the correct compression depth and rate. The rescuer should kneel beside the person and position their shoulders directly over their hands. The arms must be kept straight with the elbows locked, allowing the rescuer to use their upper body weight to drive the compressions. This posture allows for the delivery of the required depth—at least two inches for an adult—at a rate of 100 to 120 compressions per minute, while also reducing rescuer fatigue.
Adapting Placement for Children and Infants
The fundamental principle of compressing the center of the chest remains the same, but the technique and tool used for compression must be scaled down for children and infants. For children typically aged one year to puberty, the hand placement is still the center of the chest on the lower half of the sternum. However, depending on the child’s size and build, a rescuer may use the heel of only one hand for compressions.
If the child is larger or if the rescuer is unable to achieve the required depth of about two inches with one hand, both hands may be used, similar to the adult technique. The goal is to use the minimal force necessary to achieve the proper compression depth, which is about one-third the depth of the child’s chest. This adjustment prevents excessive force from causing injury to the smaller body structure.
For infants younger than one year, the compression technique changes significantly, requiring the use of only two fingers. The correct placement is the center of the chest, specifically on the sternum just below the nipple line. The rescuer uses the tips of the index and middle fingers, or the tips of the middle and ring fingers, to deliver compressions.
An alternative technique, often used by two rescuers, is the two-thumb encircling technique, where the thumbs are placed side-by-side on the same spot. The compression depth for an infant is approximately 1.5 inches, or about one-third the depth of the infant’s chest.
Common Errors and Safety Considerations
Incorrect hand placement can significantly reduce the effectiveness of CPR and increase the risk of serious complications. A common error is positioning the hands too low, which can lead to compressions being applied to the xiphoid process, the small cartilage at the bottom of the sternum. Pressing on this area, or too low on the abdomen, can potentially damage internal organs like the liver.
Another frequent mistake is applying pressure over the ribs instead of the sternum, often by failing to lift the fingers off the chest wall. This can result in rib fractures, which are possible even with correct placement, but the risk is substantially higher if the force is not centralized. Ensuring that only the heel of the bottom hand is in contact with the sternum directs the force where it is needed most.
Proper placement is also dependent on access to the chest, making it important to remove or open any clothing that obstructs the view of the chest landmarks. Correct hand position ensures that the compressions are effective in circulating blood, which is the procedure’s primary purpose. Focusing on this technique minimizes the potential for injury while maximizing the chances of a positive outcome.