Ну где-то вот таким образом:

Public Function InsertImage(adocn As Connection, m_name As String, m_text() As Byte, m_len As Long, _
    m_checksum As Long, ByVal m_id As Long) As Long
    
    Dim cmd          As New ADODB.Command
    Dim rs           As New Recordset
    Dim p1           As New ADODB.Parameter
    Dim p2           As New ADODB.Parameter
    Dim p3           As New ADODB.Parameter
    Dim p4           As New ADODB.Parameter
    Dim p_out        As New ADODB.Parameter
    
    On Error GoTo ERRH
    
    Set cmd.ActiveConnection = adocn
    cmd.CommandText = "InsertImage"
       
    cmd.CommandType = adCmdStoredProc

    Set p1 = cmd.CreateParameter("@name", adVarChar, adParamInput,  255 )
    cmd.Parameters.Append p1
    Set p2 = cmd.CreateParameter("@text", adLongVarBinary, adParamInput, m_len)
    Set p3 = cmd.CreateParameter("@checksum", adInteger, adParamInput)
    Set p4 = cmd.CreateParameter("@id", adInteger, adParamInput)
    Set p_out = cmd.CreateParameter("@id_out", adInteger, adParamOutput)
    cmd.Parameters.Append p_out
                
    p1.Value = m_name
    p2.AppendChunk m_text
    p3.Value = m_checksum
    p4.Value = m_id
    
    cmd.Execute
    InsertImage = p_out
    
    Exit Function

ERRH:
End Function


Public Function GetImageFromDatabase(adocn As ADODB.Connection, source_path As String, _
    temp_path As String) As Boolean
        
    Dim rs As New Recordset, s() As Byte
    Dim m_cn As New ADODB.Connection
    
    On Error GoTo ERRH:
    Set rs = New Recordset
    
    rs.Open "exec GetImages @name = '" & source_path & "'", adocn
    
    If Not rs.EOF Then
    
        ReDim s(rs.Fields("text").ActualSize)
        s = rs.Fields("text").GetChunk(rs.Fields("text").ActualSize)
    
        Open temp_path For Binary As # 1 
        Put # 1 , , s
        Close # 1 
        GetImageFromDatabase = True
        
    End If
    rs.Close
    Exit Function
    
ERRH:
End Function

Как вы наверное заметили, изображения удобно хранить по контрольной сумме,
и по ней же отслеживать изменения в файлах. Я успользую для этого алгоритм CRC32.
 
Вставлять новые изображения примерно следующим образом.
    
    Dim s() As Byte, CheckSum As Long
    
    Open FileName For Binary As # 1 
    ReDim s(LOF( 1 ))
    Get # 1 , , s
    Close # 1 
    CheckSum = CalcCheckSum(FileName)
    
    Call InsertImage(Connect, FileName, s, UBound(s) +  1 , CheckSum)
    
За подробностями - в мыло.

Create        PROCEDURE InsertImage @name varchar( 255 ),@Text image, @Checksum int, @id_out int output AS

	insert into Images values(@name, @text, @Checksum)
	select @id_out =  scope_identity()

GO

Create PROCEDURE GetImages @name varchar( 255 )  AS
	
	select text from Images where Name = @name

GO