NUR242 IV CPE COMPLETE TEMPLATE
Clinical Performance Evaluation –
Intravenous Skills
NUR242 IV CPE COMPLETE TEMPLATE
Clinical Performance Evaluation – Intravenous Skills
Galen College of Nursing | 2025/2026 Edition
CPE A: IV INSERTION TEMPLATE
To be successful, you must demonstrate ALL of the following components.
Failure to complete any critical element results in an unsuccessful CPE attempt.
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SECTION 1: STANDARD PRECAUTIONS & SAFETY
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☐ HAND HYGIENE: Perform hand hygiene before ANY patient contact, as
appropriate during the procedure, and before leaving the patient area.
☐ GLOVES: Wear gloves as appropriate for the procedure.
☐ WASTE DISPOSAL: Dispose of trash in the trash can; dispose of sharps in
1
, the correct receptacle (sharps container).
☐ PRIVACY: Provide privacy by closing the curtain or door.
☐ PATIENT IDENTIFICATION: Verify the patient using two identifiers (e.g.,
name, date of birth, medical record number). Confirm allergies.
☐ PHYSICAL SAFETY: Protect the patient from physical harm at all times
(e.g., secure equipment, raise side rails as needed, ensure safe
environment).
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SECTION 2: COMMUNICATION & EMOTIONAL SECURITY (AIDET)
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☐ AIDET CONSISTENTLY: Use AIDET throughout the patient interaction:
- Acknowledge the patient
- Introduce yourself (name, role)
- Duration (explain how long the procedure will take)
- Explanation (explain what you are doing step by step)
- Thank you (thank the patient for their cooperation)
☐ RESPECTFUL INTERACTION: Actively interact with and treat the patient
with respect at all times, as if they are a real person (not a manikin).
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SECTION 3: CRITICAL THINKING & ASSESSMENT
----------------------------------------------------------------------------
2
Clinical Performance Evaluation –
Intravenous Skills
NUR242 IV CPE COMPLETE TEMPLATE
Clinical Performance Evaluation – Intravenous Skills
Galen College of Nursing | 2025/2026 Edition
CPE A: IV INSERTION TEMPLATE
To be successful, you must demonstrate ALL of the following components.
Failure to complete any critical element results in an unsuccessful CPE attempt.
----------------------------------------------------------------------------
SECTION 1: STANDARD PRECAUTIONS & SAFETY
----------------------------------------------------------------------------
☐ HAND HYGIENE: Perform hand hygiene before ANY patient contact, as
appropriate during the procedure, and before leaving the patient area.
☐ GLOVES: Wear gloves as appropriate for the procedure.
☐ WASTE DISPOSAL: Dispose of trash in the trash can; dispose of sharps in
1
, the correct receptacle (sharps container).
☐ PRIVACY: Provide privacy by closing the curtain or door.
☐ PATIENT IDENTIFICATION: Verify the patient using two identifiers (e.g.,
name, date of birth, medical record number). Confirm allergies.
☐ PHYSICAL SAFETY: Protect the patient from physical harm at all times
(e.g., secure equipment, raise side rails as needed, ensure safe
environment).
----------------------------------------------------------------------------
SECTION 2: COMMUNICATION & EMOTIONAL SECURITY (AIDET)
----------------------------------------------------------------------------
☐ AIDET CONSISTENTLY: Use AIDET throughout the patient interaction:
- Acknowledge the patient
- Introduce yourself (name, role)
- Duration (explain how long the procedure will take)
- Explanation (explain what you are doing step by step)
- Thank you (thank the patient for their cooperation)
☐ RESPECTFUL INTERACTION: Actively interact with and treat the patient
with respect at all times, as if they are a real person (not a manikin).
----------------------------------------------------------------------------
SECTION 3: CRITICAL THINKING & ASSESSMENT
----------------------------------------------------------------------------
2
