Set pasta machine to its' widest setting. Flatten one piece of pasta dough with your hands or a rolling pin. Feed the flattened dough through the roller as you turn the crank.
Place the dough lengthwise in front of you. Fold each side over in thirds. Repeat the process 3-4 times until the dough is smooth and the width of the pasta roller. This is the important step where you are trying to make a single piece of smooth dough with even edges that are the width of your machine. Keep rolling it until you have fairly smooth edges, even if it takes 10 times.
Adjust the pasta roller to the next setting and feed the dough through again. Repeat this process, adjusting the roller to a narrower setting each time until you reach the desired thickness for your pasta.*
When a piece is too long to manage, lay it on the counter and cut it in half.
Once your pasta is the desired thickness it can be cut into any shape. Repeat this process with the remaining portions of dough. Shape as desired.
Many hand-crank machines have a setting for fettuccini so that's a great place to start.
As each piece of pasta is cut into fettuccini carefully twist and twirl into a loose nest. Lay on a baking sheet to dry slightly as you repeat the process with each piece of dough.
If not using within 30 minutes cover and refrigerate. Cook within 3 days.