The patient lies on their back and the pumper sits on their right side. Place the palm of the RIGHT hand over the RIGHT lower rib cage just inferior to the breast on the right side of the chest place the left hand comfortably over the right. The RIGHT thumb should circle down over the side towards the patient's back if the hand is large and the patient small. The finger tips should reach almost to the midline of the body depending on how large the hands are.
Exert a pressure towards the left side and towards the middle of the back and down towards the belly button all in one motion. The idea is to exert a squeezing type pressure down on the liver to cause it to express its contents. It is almost like milking a cow. Be sure and allow all the pressure to come off the hand when you bring it back at the end of the push. Leave the hand in place during the pumping, don?t raise it off the chest on each pump.
Pump the liver for at least a minute with about one pump every two three or four seconds.