El tipo de enfoque que recomendaría es tener un campo en el registro que indique si el registro se está procesando o no. Luego implemente un sproc de "leer a continuación de la cola" que haga lo siguiente, para garantizar que no haya 2 procesos que recojan el mismo registro:
BEGIN TRANSACTION
-- Find the next available record that's not already being processed.
-- The combination of UPDLOCK and READPAST hints makes sure 2 processes don't
-- grab the same record, and that processes don't block each other.
SELECT TOP 1 @ID = ID
FROM YourTable WITH (UPDLOCK, READPAST)
WHERE BeingProcessed = 0
-- If we've found a record, set it's status to "being processed"
IF (@ID IS NOT NULL)
UPDATE YourTable SET BeingProcessed = 1 WHERE ID = @ID
COMMIT TRANSACTION
-- Finally return the record we've picked up
IF (@ID IS NOT NULL)
SELECT * FROM YourTable WHERE ID = @ID
Para obtener más información sobre estas sugerencias de tablas, consulte MSDN
