For adult CPR, place the heel of one hand in the center of the chest, right between the nipples, then stack your other hand on top and interlace your fingers. That two-hand position on the lower half of the breastbone is the foundation of effective chest compressions, whether you’re trained in full CPR or performing the hands-only version recommended for bystanders.
Exact Hand Position for Adults
Your contact point is the heel of your palm, the firm, fleshy part where your hand meets your wrist. Place it on the breastbone just below the nipple line. Then place your other hand directly on top and interlace your fingers, pulling them upward so they lift off the person’s chest. Only the heel of your bottom hand should press into the body. This distributes compression force evenly across the breastbone and reduces the chance of concentrated pressure on individual ribs.
It does not matter which hand goes on the bottom. Use whichever feels more natural and stable. What matters is that your hands stay centered and don’t drift to one side of the chest or slide down toward the stomach.
Body Position and Arm Mechanics
Hand placement alone won’t produce effective compressions. Your entire upper body needs to be aligned correctly. Kneel beside the person and position your shoulders directly over your hands so your arms form a straight vertical line. Lock your elbows so your arms stay rigid. You compress using your body weight, not your arm muscles. Think of your arms as pistons: stiff, straight, transferring force from your torso through your shoulders and into the chest.
This alignment matters because effective adult CPR requires compressions at least 2 inches deep, delivered at a rate of 100 to 120 per minute. That’s roughly the tempo of the song “Stayin’ Alive.” Bent elbows or off-center shoulders will tire you out quickly and produce shallow, inconsistent compressions that don’t move enough blood.
Why Full Chest Recoil Matters
Between each compression, let the chest come all the way back up to its resting position. This is called full recoil, and it’s just as important as pushing down. When the chest springs back, it creates a vacuum effect inside the ribcage that draws blood back into the heart. Without that refill, the next compression has less blood to pump out to the brain and other organs.
A common mistake is leaning on the chest between compressions, especially as fatigue sets in. Keep your hands in contact with the chest so you don’t lose your position, but release all downward pressure. If someone else is available, switch off every two minutes to maintain compression quality.
Hand Placement for Children and Infants
For children (roughly age 1 through puberty), compressions go in the same spot: the center of the chest. You can use one hand or two depending on the child’s size. Push to a depth of about 2 inches, the same as for adults, at the same rate of 100 to 120 per minute.
Infants under 1 year old require a completely different technique. Use two fingers (your index and middle finger, or middle and ring finger) placed on the center of the chest, just below the nipple line. Push to a depth of about 1.5 inches. The target rate stays the same. For infants and children, current guidelines recommend conventional CPR with rescue breaths rather than the hands-only approach used for adults.
Common Placement Errors
Placing your hands too high on the chest compresses the upper breastbone without effectively squeezing the heart, which sits lower and slightly left in the chest cavity. Placing them too low risks pushing on the tip of the breastbone or the upper abdomen, which can injure the liver or stomach without delivering useful compressions.
Hands that drift to one side concentrate force over the ribs instead of the breastbone. Ribs are more flexible and more prone to fracture under direct pressure. Rib fractures during CPR are not uncommon even with correct technique (the force required to compress the chest 2 inches is substantial), but poor hand placement increases the risk significantly. In rare cases, misplaced force can cause a collapsed lung or bruising of internal organs. These risks are real, but they’re always outweighed by the need to restore blood flow during cardiac arrest.
Modifications for Pregnant Individuals
Hand placement stays the same for someone who is pregnant: center of the chest, heel of the hand, fingers interlaced. The key modification involves the person’s body position. In later pregnancy, the weight of the uterus can compress major blood vessels when the person is lying flat on their back, reducing how much blood returns to the heart. If another rescuer is available, they should kneel beside the person and manually push the belly toward the left side to shift the uterus off those vessels. If you’re alone, focus on high-quality compressions in the standard position.
Hands-Only CPR for Bystanders
If you’re not trained in CPR or aren’t comfortable giving rescue breaths, hands-only CPR is the current recommendation for adult cardiac arrest. Call 911, then push hard and fast in the center of the chest without stopping. No mouth-to-mouth is needed. Studies consistently show that bystander hands-only CPR dramatically improves survival compared to doing nothing while waiting for paramedics. The same hand placement, depth, and rate guidelines apply. Your job is to keep blood circulating until professional help arrives.