Where are the thumbs placed during chest compression in newborn?

KPSC Staff Nurse - 2021

Child Health Nursing (Pediatrics)

Easy

Appeared in: KPSC Staff Nurse - 2021

Explanation

The correct placement for chest compressions in a newborn is the lower third of the sternum.
This area is located just below an imaginary line connecting the nipples (the intermammary line).
This specific positioning allows for effective compression of the heart, which lies beneath this part of the sternum.
Using this landmark minimizes the risk of compressing the xiphoid process, which can cause damage to the liver.

Option A: Compressing on the upper third of the sternum is too high. It is ineffective for cardiac compression and can cause injury to the manubrium and other structures in the upper chest.
Option B: Similar to the upper third, the upper half of the sternum is an incorrect placement. It is not positioned directly over the heart's ventricles, leading to ineffective compressions.
Option C: This option is too imprecise. While the correct site is within the lower half, the guidelines specify the lower third to provide a more exact and safer landmark, specifically to avoid the xiphoid process at the bottom of the sternum.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Neonatal Resuscitation: Chest Compression Technique as background academic context rather than a clinical decision trigger.
Correct hand placement during neonatal CPR is a critical skill for nurses, as improper technique can lead to ineffective resuscitation and severe iatrogenic injuries, such as rib fractures, pneumothorax, or liver laceration.
Chest compressions are initiated in a newborn if the heart rate remains below 60 beats per minute after 30 seconds of effective positive-pressure ventilation.
What if there is only one rescuer? The two-finger technique (using the tips of the middle and index fingers on the lower third of the sternum) is an alternative. However, the two-thumb encircling method is preferred as it generates higher blood pressure and coronary perfusion with less rescuer fatigue.

How to Approach the Question

First, identify the core of the question, which is about a specific procedural detail in neonatal resuscitation: hand placement for chest compressions.
Recall the guidelines for Neonatal Resuscitation Program (NRP) or Basic Life Support (BLS) for infants.
Visualize the anatomy of a newborn's chest, including the sternum, nipple line, and xiphoid process.
Evaluate the options based on safety and effectiveness. Eliminate placements that are too high (upper third/half) as they are ineffective and dangerous.
Differentiate between the remaining options ('lower half' vs. 'lower third'). Choose the most precise and specific landmark provided in clinical guidelines, which is the 'lower third' of the sternum, to ensure avoidance of the xiphoid process.

Concept Tested & Keywords

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E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 1 (pp 36-238 of 713) p. 166-168

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 763-765