How do I position my hands for CPR?

Performing Cardiopulmonary Resuscitation (CPR) can be an intimidating experience. Not only can we possibly save a life, the act of CPR itself can be a bit strenuous. With such an important activity, many people don’t realize the importance of their own comfort in creating success.

One of the key components to successful CPR is proper depth of compressions. To be able to keep the depth consistent throughout a resuscitation, being physically comfortable is very helpful. It’s human nature; if we are uncomfortable or in pain, we are much less likely to push hard enough for very long. This is where our choice of hand position can be very important! There are many options for a good hand starting position, and we need to keep in mind as well that it’s OK to adjust and change our position as we work to stay as comfortable as we can. This way we are much more likely to continue to provide high quality CPR.

Here we will discuss some good options for hand positions for both adults, children, and infants. Keep in mind that these are starting points for placement and you should feel free to make adjustments that are most comfortable for you.

ADULT & CHILD Clasped hands

This position is the most popular and has the advantage of keeping pressure centered in a downward push. To begin, place one palm/heel of your hand straight down flat and pull your fingers slightly upward. Place your other hand directly centered over the first, and clasp your fingers interwoven for both hands. It does not matter which hand is on top or on the bottom, place them according to what is most comfortable for you.

ADULT & CHILD Open hands

This position is a popular adaptation of the clasped hands, and can have the advantage of feeling a bit more stable by spreading out the push distribution slightly. It can also help in the instances of finger injury, when bending fingers is painful or limited. To begin, place one palm straight down flat and rest your fingers lightly in the spread out position. Place your other hand directly centered over the first, making sure your fingers alternate with each other, so all fingertips lightly touch the chest.

Another popular variation to the open hands positioning is crossing the hands one over the other in an “X” formation, with the center of the X placed in the center of the chest. It can allow the pressure of the compression to be spread out differently between the hands, another option to maintain comfort.

ADULT & CHILD Fists

This position is a specific alternative for those who feel more comfortable pressing with a closed fist. It can help keep wrists straighter than the more traditional flat hand positions. It can be helpful in cases of previous wrist injuries or pain. Often this position is performed with one arm only, but two hands can be used if the fists are held very close together to keep the pressure centered on the chest. To use this position, make a fist with one hand and place the fist finger/knuckles down in the center of the chest. If using two hands, face the hands with wrists touching or close inward toward each other. You can also use one fist to compress and the other hand to support the wrist or fist, if desired.

INFANT Two Finger

This position is the most traditional finger position for infant compressions. This involves placing your pointer and index finger next to each other on the center of the chest of the infant. Your hand should be upright, as if you are pointing directly into the center of the chest. To compress, push directly down. A popular adaptation to this position involves supporting the pushing hand with your other hand by grasping and pressing down on the pressing hand. The adaptation can help avoid the fatigue that can be associated with pushing with only one hand/arm for extended periods of time.

INFANT Two ThumBS ENCIRCLING

This position has the advantage of allowing both hands to push equally, and can help extend the amount of time performing compressions in comfort by displacing the pressure over both hands. To perform compressions using this technique, rest your fingertips on the platform which is supporting the infant in distress. Your hands should gently cradle the sides of the infant, naturally positioning your thumbs in the center of the chest. To compress, the thumbs rotate down and up, inward and outward. This position can be performed facing either the feet or head of the infant.

INFANT Knuckle

this position is an adaptation of the two finger technique, utilizing one or two knuckles to push straight into the chest, instead of finger tips. To perform this technique, curl your fingers into a fist, allowing one or two knuckles to stick out a bit and point them down straight into the center of the chest. Compress straight down with either one hand, or use the second hand to help push the hand down if desired.

Those hand positions are some options to get you started, and remember it’s ok to make some more variations for your comfort, as long as you can compress in the correct location. And of course the best way to make sure you are comfortable and confident is to PRACTICE! Hands on practice builds muscle memory and helps you understand how to move your body to be the most effective and maybe even save someone’s life!! An instructor can also help you find the most advantageous position for you, and coach technique to help you feel your most confident. Because when we are confident in our skills, we are more likely to act in an emergency.

Learn more about CPR hand positioning during a BEACON by Code One Heartsaver CPR AED course!